2015 2016...14-br-ca 36 1-888-315-0447 claims appeals, unitedhealthcare studentresources, po box...

14-BR-CA 04-320-1/2

2015–2016

14-BR-CA

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UnitedHealthcare ..................................................................................................................................................... 5

– ..................................................................................................................................................... 7

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(SHC) ..................................................................................................................... 19

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UnitedHealthcare Global .............................................................................................................................. 24

NurseLine ........................................................................................................................................................... 25

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UnitedHealth Allies ................................................................................................................................................................ 26

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......................................................................................................................................................................... 35

Gallagher Student Health & Special Risk .............................................................................................................. 37

14-BR-CA 1

1-866-948-8472

www.uhcsr.com

2015-320-1 7 ( 3 )

(F-1 J-1 M-1 )

2015-320-2 / 5 ( 3 )

3

31

26

2015 8 1 12:01 ( )

2016 8 14 11:59

01-10-2016

08-14-2016

– 1-800-406-4517

www.gallagherstudent.com

30

http://www.gallagherstudent.com/

14-BR-CA 2

UnitedHealthcare

1) : 1-877-295-0720

2) 1-877-295-0720

UnitedHealthcare 8:00 6:00

1-877-295-0720

UnitedHealthcare Options PPO

1-866-948-8472 ( )

–

UnitedHealthcare Options PPO United Behavioral Health (UBH)

1-866-948-8472

–


PPO

1)

2)

14-BR-CA 3

PLATINUM

( )

$150 ( )

$300 ( )

80%

60%

$1,500 ( )

$3,000 ( )


100%

( 1)

X /

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80% 60%

80% 60%

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14-BR-CA 4

50%

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UHCP 90

UnitedHealthcare (UHCP)

75%

31

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14-BR-CA 5

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UnitedHealthcare (PDL)

PDL

PDL

www.uhcsr.com 1-855-828-7716

75% 31

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14-BR-CA 6

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14-BR-CA 7

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14-BR-CA 8

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14-BR-CA 9

(CPT) 80000 – 89999 ( )

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14-BR-CA 10

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14-BR-CA 11

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14-BR-CA 12

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14-BR-CA 13

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14-BR-CA 14

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14-BR-CA 15

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14-BR-CA 16

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14-BR-CA 17

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14-BR-CA 18

(HIV) HIV

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14-BR-CA 19

1)

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100%

180

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14-BR-CA 20

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14-BR-CA 21

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14-BR-CA 22

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14-BR-CA 23

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14-BR-CA 24

(Caution - limited by federal law to investigational use)

Parlodel Pergonal Clomid Profasi Metrodin Serophene

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UnitedHealthcare Global



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24 UnitedHealthcare Global

14-BR-CA 25

/

$5,000.00 ( UnitedHealthcare StudentResources )

www.uhcsr.com/UHCGlobal UnitedHealthcare Global

1-800-527-0218

1-410-453-6330

[email protected]

UnitedHealthcare Global Operations Center

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UnitedHealthcare Global www.uhcsr.com/MyAccount (My Account)


NurseLine

24

NurseLine

170

LiveAndWorkWell.com BMI

www.uhcsr.com/MyAccount

http://www.uhcsr.com/MyAccount

14-BR-CA 26

UnitedHealthcare StudentResources www.uhcsr.com/myaccount

(create My Account Now) 7

UnitedHealthcare StudentResources

(Message Center) –

(My Email Preferences)

UnitedHealth Allies

UnitedHealth Allies® UnitedHealth Allies

(UnitedHealth Allies Plan) UnitedHealth Allies

UnitedHealth Allies UnitedHealth Group UnitedHealth Allies

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UnitedHealthcare StudentResources P.O.Box 809025 Dallas, TX 75380-9025 1-866-948-8472 [email protected]

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14-BR-CA 27

1-877-816-3596

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14-BR-CA 28

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14-BR-CA 29

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3

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14-BR-CA 30

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14-BR-CA 31

UnitedHealthcare Dental Attn: Claims Unit P.O. Box 30567 Salt Lake City, UT 84130-0567

90

1-877-816-3596

15

5

–

–

24

–

–

–

–

( )

–

14-BR-CA 32

( )

Medicare

19

1) 19 2)

1

Spectera Eyecare Networks Spectera

Eyecare Networks 1-800-839-3242

Spectera Eyecare Networks www.myuhcvision.com

3

Spectera Eyecare Networks

( ) /

( 20/20 20/40)

20 16 ( )

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14-BR-CA 33

/

( ) –

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( )

$20 100%

50%

$40 100%

50%

$40 100%

50%

$40 100%

50%

$40 100%

50%

14-BR-CA 34

$130

100% 50%

$130 - $160

$15 100%

50%

$160 - $200

$30 100%

50%

$200 - $250

$50 100%

50%

$250

60% 50%

12

$40 100%

50%

$40 100%

50%

60 1 50% 50%

50% 50%

50% 50%

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2

1

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( Spectera

Eyecare Networks )

14-BR-CA 35

Claims Department P.O. Box 30978 Salt Lake City, UT 84130

1-248-733-6060

90

4

- Spectera Eyecare Networks

Spectera Eyecare Networks -

-

- 1

180

1.

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1-866-948-8472

UnitedHealthcare StudentResources, PO Box 809025, Dallas, TX 75380-9025

1.

2.

14-BR-CA 36

1-888-315-0447 Claims Appeals,

UnitedHealthcare StudentResources, PO Box 809025, Dallas, TX 75380-9025

California Department of Insurance Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, CA 90013

1-800-927-HELP (4357) 1-213-897-8921

1-800-482-4TDD (4633)

http://www.insurance.ca.gov

1-866-948-8472

California Department of Insurance Consumer Communications Bureau 300 South Spring Street, South Tower Los Angeles, CA 90013

1-800-927-HELP (4357) 1-213-897-8921

1-800-482-4TDD (4633)

http://www.insurance.ca.gov

14-BR-CA 37

Gallagher Student Health & Special Risk


UnitedHealthcare Insurance Company

gallagherstudent.com/APU (Discounts and Wellness)

EyeMed

EyeMed EyeMed 45,000

LensCrafters Sears Optical Target Optical JC Penney Optical

Pearle Vision 15% 45%

EyeMed

www.gallagherstudent.com (Discounts and

Wellness)

Basix

Basix Gallagher Student Health &

Special Risk Basix


50%

Basix

– Basix Basix

www.basixstudent.com

CampusFit

CampusFit

(Energy Management)

(Fitness Works) mp3

5

(Wellness Support) mp3

CampusFit http://campusfit.basixwellness.com

14-BR-CA 38

UNITEDHEALTHCARE INSURANCE COMPANY

Gallagher Student Health & Special Risk 500 Victory Road Quincy, MA 02171 1-800-406-4517 www.gallagherstudent.com/APU

Gallagher Student Health & Special Risk EyeMed Basix Campus Fit

www.gallagherstudent.com/APU (Discounts & Wellness)

Gallagher Student

2015-320-1 2015-320-2

v2 NOC1 (8/18/15)

14-BR-CA 39

2015-320-1

NOC#1 (8/17/15)

– /

- ( 72 )

- ( )

( )

(

)

/ ( 12 / $30 ) 100%

$25 / 60% $25

–

(Caution - limited by federal law to investigational use)

Parlodel Pergonal Clomid Profasi Metrodin Serophene

19

(1)

(

)

14-BR-CA 40

26 - 30

1)

2)

1) 2) 31

(1) (2)

California

1)

2)

3) 18 18 California

a.

b.

4)

1) 2)

3) 4)

24 5) 6)

1)

2)

3)

4)

5)

/

14-BR-CA 41

48

96

31

A B

( )

( )

FDA 90

FDA


-

( )


14-BR-CA 42

a. X

b.

c.

d.

e. (HIV)

f.

g.

h.

i.

(California )

2015 2016...14-br-ca 36 1-888-315-0447 claims appeals, unitedhealthcare studentresources, po box...

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