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 preventive care services, including immunizations such as MMR, TDAP, chickenpox, etc, and will be paid 100% of preferred allowance within our in-network providers. For patients wishing to receive vaccines in the school health center, they may need to pay the medical expense first and send the claim to UHCSR by himself/herself. For visiting in-network doctors or hospitals, healthcare claims will be submitted by providers directly. To find an in-network hospital or doctors, please visit our official website at smcovered.com and then click on find 'find care' under 'visit your doctor' to enter your zip code to find hospitals in the network near your school.
2. How can I get vaccines:
We recommend receiving your vaccines from CVS, Rite Aid, and Walgreen (except MMR/Chickenpox), or your school health care center. CVS clinic needs an appointment, and please call in to ask if there is any vaccine inventory. To find other in-network pharmacies, you can find an in-network pharmacy after entering your zip code on our website here: https://www.optumrx.com/oe_rxexternal/pharmacy-locator?type=ClientPharmacy&var=UXZA6737&infoid=%2520UXZA6737&page=&par=. (need to schedule an appointment)
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 HPV 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 hospital may have to contact UnitedHealthcare to get your insurance information. Please let the staff check into the UHCSR system or contact the "Customer Service" phone number on your insurance card: 1-866-352-8632 since UnitedHealthcare Student Resources and United Health Care are using two different systems. The insurance company will then instruct the pharmacy staff on the phone and complete the bill on the spot.
4. Prescription Drug
Benefits are available for Prescription Drugs for in-network pharmacies if you enrolled in one of these plans: Global care basic /Global care plus/Prime 500/Prime 100/Elite/Supreme. Benefits are subject to supply limits and Co-payments and/or Coinsurance that vary depending on which tier of the Prescription Drugs List the outpatient drug is listed. For example, the supreme plan has $15 Copay per prescription for Tier 1, a $30 Copay per prescription for Tier 2, $50 Copay per prescription for Tier 3 up to a 31 day supply per prescription. And the elite plan has a $15 Copay per prescription for Tier 1, 30% per prescription for Tier 2, and 50% per prescription for Tier 3 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 contact 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 first, and then file a claim within 90 days after your visit to get the reimbursement.