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Forms – University of North Alabama

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 North Alabama

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.

 

Travel Assistance, Evacuation & Repatriation – University of North Alabama


 

Global Emergency Services (GES)

Have some peace of mind while traveling. We’ve heard great stories about GES saving the day for students who are studying or traveling in other states or other countries. When you’re at least 100 miles from home and you’re sick or hurt, GES steps in with immediate assistance and evacuation benefits. They can even help you get home if you need to be medically evacuated.

Some benefits of this service include:

  • Emergency Medical Evacuation
  • Dispatch of Doctors/Specialists
  • Medical Repatriation
  • Transportation after Stabilization
  • Transportation to Join a Hospital Insured Person
  • Return of Minor Children
  • Repatriation of Remains
  • May also include additional assistance services to support your medical needs, including worldwide medical referrals and medication/vaccine transfers.
  • Contact information is on the back of your SR ID card or in My Account

 

For more information on Global Emergency Services, please review the Assistance and Evacuation Benefits section in your Brochure-Certificate.

Travel Assistance, Evacuation & Repatriation – University of North Alabama


 

Global Emergency Services (GES)

Have some peace of mind while traveling. We’ve heard great stories about GES saving the day for students who are studying or traveling in other states or other countries. When you’re at least 100 miles from home and you’re sick or hurt, GES steps in with immediate assistance and evacuation benefits. They can even help you get home if you need to be medically evacuated.

Some benefits of this service include:

  • Emergency Medical Evacuation
  • Dispatch of Doctors/Specialists
  • Medical Repatriation
  • Transportation after Stabilization
  • Transportation to Join a Hospital Insured Person
  • Return of Minor Children
  • Repatriation of Remains
  • May also include additional assistance services to support your medical needs, including worldwide medical referrals and medication/vaccine transfers.
  • Contact information is on the back of your SR ID card or in My Account

 

For more information on Global Emergency Services, please review the Assistance and Evacuation Benefits section in your Brochure-Certificate.

File a Medical Claim – CBIZ Benefits & Insurance Services, Inc.


Submit a Claim by Mail


It’s easy! Just download the claim form below. Fill out the first page with your personal information, dates of injury or sickness, the cause of the injury or date of first symptoms for a sickness, sign your name with today’s date, and attach all receipts. Please fill out the entire first page and be sure not to leave anything blank.

Mail Claim Forms to:

UnitedHealthcare StudentResources
PO Box 809025
Dallas, TX 75380-9025

Medical Claim Form


Submit a Claim Electronically

Your Doctor can also submit a claim electronically using Emedeon (formerly WebMD). This gives a faster turn-around time than submitting a claim by mail. Check with your doctor to see if they are a participant. If they are, show them your ID Card. The Emedeon information is printed on the back of every ID Card.

If you have any problems filling-out these forms or would like to talk to a customer service representative, you can call us toll free at: 1-888-251-6253 or CONTACT US

Student Assistance Plan – CBIZ Benefits & Insurance Services, Inc.

College life is exciting but it can also be stressful if you are balancing class with personal responsibilities. In addition, you may be facing more serious issues like family matters, depression, or substance abuse that you can’t handle by yourself. Don’t let problems keep you from enjoying college and preparing for the future. Get the help you need today!

Health Advocate will provide you with the right tools to help you through some of life’s toughest challenges. Students can call Health Advocate’s toll-free number for confidential, short-term professional assistance, focusing on coping skills for a full range of emotional, family, and other personal issues.

A Licensed Professional Counselor will… 

  • Provide confidential, short-term, telephonic counseling.
  • Offer referrals for long-term counseling or specialized care, as needed.
  • Address stress, depression, family issues, substance abuse and more.
  • Provide assistance with budgeting and other financial concerns.
  • Research child care and eldercare resources.
  • Be available via telephone 24/7 in a crisis.

Call anytime 24/7 1-866-799-2670.

REMEMBER: Call 911 or go to the ER in an emergency.