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File a Claim – University of Montevallo

You can submit claim via My Account, mail or fax. Review details in Claim Center.

Below information provides details of what is needed to submit a medical or prescription claim.

File a medical claim


To file your medical claim for consideration, please provide the following information. All submitted documents must be legible.

    • A copy of your medical ID card as well as the patient information, if different than the primary insured.
    • Medical claims – must be an itemized bill listing each service provided, diagnosis, the service date, and the cost per service. The provider’s name, tax ID number, address and phone number should also be included. Grouped services are not considered an itemized bill. Claims missing any of the requirements listed above will be denied for reimbursement until the required information is submitted.
    • Proof of payment – if payment was made by check, please provide a copy of the front and back of the cancelled check. For all credit card payments, the credit card statement showing the cardholder’s full name, institution name and payment information for each date of service is required. If payment was made with an ATM or Debit card, the bank statement showing the accountholder’s full name, institution name and payment information of each date of service is required. We will call the provider of services to verify all cash payments.
    • Be sure to include your current mailing address.

File a prescription claim


To file your prescription, claim for consideration, please provide the following information. All submitted documents must be legible.

    • A copy of your medical ID card as well as the patient information, if different than the primary insured.
    • A copy of the prescription label showing the patient name, prescribing doctors name, drug name, date dispensed, quantity and purchase price for each prescription
    • Proof of payment – if payment was made by check, please provide a copy of the front and back of the cancelled check. For all credit card payments, the credit card statement showing the cardholder’s full name, institution name and payment information for each date of service is required. If payment was made with an ATM or Debit card, the bank statement showing the account holder’s full name, institution name and payment information of each date of service is required. We will call the provider of services to verify all cash payments.
    • Be sure to include your current mailing address.

Note: If the claim is for Optum Rx, please visit the Optum Rx Web Portal to submit your prescription claims.

Claim Center – University of Montevallo

Below you will find all the information you need to file claims, request a claim review, and to check your claim statuses.

Request a claim review


Sign in to your My Account, identify the claim you would like reviewed, select Request a Claim Review and follow the on-screen prompts.

Check claim status


Please visit My Account to create or sign in. Once logged in, go to Claims Summary to check the status of the claim submitted by you or your provider.

Submit claims via:


Online

Create or sign in to My Account

Mail

UnitedHealthcare Student Resources
P.O. Box 31201
Salt Lake City, UT 84131

Fax

Attn: Claims Department
469-229-5625

Claim Center – University of Montevallo

Below you will find all the information you need to file claims, request a claim review, and to check your claim statuses.

Request a claim review


Sign in to your My Account, identify the claim you would like reviewed, select Request a Claim Review and follow the on-screen prompts.

Check claim status


Please visit My Account to create or sign in. Once logged in, go to Claims Summary to check the status of the claim submitted by you or your provider.

Submit claims via:


Online

Create or sign in to My Account

Mail

UnitedHealthcare Student Resources
P.O. Box 809025
Dallas, TX 75380-9025

Fax

Attn: Claims Department
469-229-5625

Waive Your School’s Insurance – University of Montevallo

Welcome to the Waive Your School’s Insurance Center!

This page is for those students who wish to opt-out (waive) out of the coverage under their school’s student insurance plan. The school’s student insurance plan can only be waived if the student has coverage that meets all requirements.

The first step to waive out of your school’s student insurance coverage is to verify that you are an eligible student.

 2023-2024 Waiver Information

Hard Waiver Student Eligibility

All International Students regardless of Credit Hours are required to purchase this insurance plan unless proof of comparable coverage is furnished. Eligible students who do enroll may also insure their Dependents. US Citizens are not eligible for coverage as a student or dependent.

For those students who do not submit an approved waiver form before the deadline, you will be required to purchase the Student Health Insurance Plan.  Please refer to the “Enroll Now” tab for further instructions.   If you do not meet one of these requirements a hold will be placed on your student account and you will be unable to enroll in classes.

Once enrolled there are no refunds or cancellations.

Please Note:  If you waive the insurance you will not be eligible to enroll until the following semester unless you experience a Qualifying Life Event.

 

Hard Waiver Student Waiver Instructions

Waiver Deadlines:

  • Annual:  8/1/24 – 7/31/24
  • Fall: 8/1/24 – 12/31/24
  • Spring: 1/1/25 – 5/4/25
  • Summer: 5/5/25 – 7/31/25


 

Please note to submit your waiver you will be asked to login using your Student ID number. 

After you verify that you are a hard waiver student and have other insurance you will need the following to waive:

  • Student ID #
  • Your current health insurance plan ID card,
  • Your health insurance brochure or plan description . There might be a few questions about your current plan.


Once you have completed the waiver form, an email will automatically be sent to the email address you provided notifying you of the waiver request decision. If you receive a:

  • Pending e-mail– Your waiver request has not been accepted; it is in a pending status. Please check you email for all updates to your waiver status.
  • Approval e-mail– Your waiver was approved. You should print this e-mail and save it with your records. Please note, each semester you will be required to do a waiver.
  • Denial e-mail– Your waiver was denied. If you would like us to look this over or if you answered a question incorrectly, please contact us.


Please Note:  If you waive the insurance, you will not be eligible to enroll until the following semester, unless you experience a Qualifying Life Event.

Qualifying Life Event

If you did not enroll during your open enrollment period and have since lost coverage under your original plan, you may qualify for a Qualifying Life Event upon providing proof of involuntary loss of coverage and payment within 30 days of losing coverage.　(example: marriage, divorce, loss of job, etc) The enrollment form, check or money order, and the letter of creditable coverage must be received within 30 days of losing coverage. After 30 days the student will no longer be eligible to enroll in the plan until Fall of the following school year.

Please CONTACT US for cost and enrollment information as a Qualifying Life Event.

If you have any questions about the enrollment process, please call 1-888-251-6253 or CONTACT US

We are always happy to help in any way.

Privacy Policy

 

 

 

Student Assistance Plan – University of Montevallo

Your student health plan includes Student Assist.

Student Assist perks:

  • 24/7 Crisis support with master’s level specialists
  • Licensed professional to help with legal and financial issues
  • Self-help app to address stress, anxiety, and depression
  • Direct access to concierge services
  • Mediation Services Available

 

Sign in to your My Account to learn more.

Student Assist Flyer

 

 

 

 

Forms – University of Montevallo

Claim form* Standard form to provide notice of medical/prescription and/or provide details on requests for additional information.

 
Authorization to use or disclose health information This form allows an insured to provide specific instructions to UnitedHealthcare Student Resources International for use or disclosure of protected health information for a particular purpose.

 
Personal Representative Appointment* This document allows an insured to appoint a personal representative to act on their behalf in the matters of health insurance with UnitedHealthcare Student Resources International.

*You can submit the form online by signing in to My Account.

 

Find a Doctor – University of Montevallo

Please use this link below to search for preferred doctor, medical specialist, hospital or lab or receive cost estimates for you or any member covered under this plan.

Find preferred providers*

* Your actual costs could vary. Check with your provider to confirm the cost and your health plan for benefits. You are responsible for costs that are not covered and for getting any referrals if required by your health plan. Neither payments nor benefits are guaranteed.

Note: Provider networks change periodically. To ensure that a provider is participating in the network, please confirm with your provider before making an appointment.

Behavioral health

Please use the link below to search for behavioral health provider or facility.

Find behavioral health providers

Virtual Services

Your plan gives you free access to virtual Medical and Mental Health care.

Sign in to your My Account to learn more.

 

Legal


Contact


1-888-251-6253
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