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.
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.
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.
* 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.
My Account is a secure website that will provide you with personalized benefits and health plan information.
You’ll have 24/7 access to:
View your benefits and coverage details
View/download Digital ID card
Submit claims, check claim status and EOB
Review and respond to claim letters
Update personal information
Search for a preferred provider
Create* or Sign in to your My Account to access or manage your plan.
*You will be able to create your My Account 24-48 hours after your initial purchase of plan. Be sure to use the email address you used to purchase plan.
Welcome to the Student & Dependent Enrollment Center! Here you will find all the necessary tools to enroll in your school sponsored policy.
We suggest you review the certificate for your rates, effective dates before starting the enrollment process. The plan’s benefits can be found in the certificate within the Schedule of Benefits section with the exclusions towards the back.
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
Eligible students who do enroll may also insure their Dependents. Eligible Dependents are the student’s legal spouse and dependent children under 26 years of age. Dependent Eligibility expires concurrently with that of the Insured student.
U.S. citizens are not eligible for coverage as a student or a Dependent.
Student/Dependent Enrollment Instructions
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. If you do not meet this criteria, you cannot waive the insurance plan. Please utilize the below enrollment link to enroll in the Global Care Basic Plan sponsored by the University of Montevallo. If you wish to waive your insurance please refer to the “Waive Your School’s Insurance” tab for further instructions.
Open Enrollment Coverage Periods for International Students
Annual: 8/1/24 – 7/31/25
Fall: 8/1/24 – 12/31/24
Spring: 1/1/25 – 5/4/25
Summer: 5/5/25 – 7/31/25
TO ENROLL PLEASE CLICK ON THE FOLLOWING LINK:
Please be sure to select I AGREE when you are asked if you wish to share your Insurance Information with your school in order for your school to verify if you are in compliance with their Insurance Requirements.
Qualifying Life Event
Students who did not enroll themselves or their dependent(s) during the open enrollment period may be able to enroll in the policy if they experience a Qualifying Life Event.
Qualifying Life Events include:
Acquiring a new family member
Marriage/Civil Union
Divorce
Loss or change of Job
Expiration of Benefits
If you and/or your dependents meet the requirements for a Qualifying Life Event, you will need to provide the following:
Proof of qualifying life event/proof of involuntary loss of coverage
Enrollment Form
Payment
All documents and payment must be received within 30 days of the qualifying life event.After 30 days, the student or dependents 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
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.
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.