1. Does my plan cover vaccines?
Our Supreme, Elite, prime 100, prime 500, global care plus, and global care basic (GC basic Maximum Benefit per policy year $1000) plans cover in-network preventive care services, including immunizations such as MMR, TDAP, chickenpox, etc., and will be paid 100% of preferred allowance when services are provided by in-network providers.
For students seeking vaccines at the school's student health center, they may need to pay the medical expense upfront and then file claims with UHCSR by themselves. When visiting in-network providers, medical claims will be submitted directly to the insurance company by providers. To find an in-network hospital or doctors, please visit our official website at smcovered.com and click on "Find an In-network Doctor" under "VISIT A DOCTOR" to enter your zip code to find doctors/clinics/hospitals in the network near you.
2. How can I get vaccines:
We recommend getting your vaccines from CVS, Rite Aid, and Walgreens (excluding MMR/Chickenpox), or your school health care center. To find other in-network pharmacies, you can find an in-network pharmacy after entering your zip code on the website here: Optum Rx
Students should call the pharmacy in advance to confirm the vaccine inventory and show the insurance card to the pharmacy before receiving the vaccine. Please note that MMR, MMRV, and Varicella(chicken pox) are not covered at Walgreen and Kroger, and the HPV vaccine is not covered at Walmart & Sam's Club.
3. Provider who cannot find the insured’s information (The pharmacy system showed "it is not covered")
The provider may contact United Healthcare Student Resources to verify your coverage. If the provider uses the United Healthcare Provider Portal, please ask them to update the Payer ID to 74227 United Healthcare Student Resources, and then search for insured member information.
The provider can also call the UHCSR Customer Service at 866-352-8632, the number listed on your insurance ID card, to confirm your coverage with the insurance company. The insurance company will assist the pharmacy staff over the phone and facilitate billing.
4. Prescription Drug
Prescription drug benefits are available for in-network pharmacies if you are enrolled in one of the following plans: Global Care Basic, Global Care Plus, Prime 500, Prime 100, Elite, or Supreme. Benefits are subject to supply limits and co-payments and/or coinsurance, which vary depending on the tier of the Prescription Drug List that the outpatient drug is categorized under.
For example, under the Supreme plan, there is a $15 copay per prescription for Tier 1 drugs, a $30 copay per prescription for Tier 2 drugs, and a $50 copay per prescription for Tier 3 drugs, up to a 31-day supply per prescription. Under the Elite plan, there is a $15 copay per prescription for Tier 1 drugs, 30% coinsurance per prescription for Tier 2 drugs, and 50% coinsurance per prescription for Tier 3 drugs, up to a 31-day supply per prescription.
5. How do I pay for my medical services?
If you bring your insurance ID with you while visiting an in-network doctor or hospital, there is no need for you to file a claim after your visit. Medical care providers will bill to the insurance company first, and then send you the rest of the bill that you need to pay. The method of payment will be found on the bill.
If you visit an out-of-network doctor or hospital, you need to pay upfront and then file a claim within 90 days after your visit.