2010-2011 SHIP UCLA University of California - Los Angeles 06-BR-CA 04-525-9
... 1... 1... 1... 2... 2... 3... 6 UnitedHealthcare... 6... 7... 8... 8... 8... 8 X... 8... 9... 9... 9... 9 AIDS... 10... 10... 10 (PKU)... 10... 10... 11... 11... 11... 11... 11... 14... 15 Scholastic Emergency Services... 15... 16... 17
800-980-4698 www.uhcsr.com/ucla UCLA SHIP ( 2010-525-1 2010-525-2) 19 23 2010 7 5 ( ) 2011 9 18 12 2010 7 1-30 2010 6 1-30 12 1-30 2010 8 1-30 12 1-30 2010 9 1-30 2010 12 1-30 2011 3 1-30 SHIPSHIP SHIP PPO / 30 UnitedHealthcare StudentResources SHIP SHIP 14 UnitedHealthcare StudentResources 1
90 UMR Care Management 1. 1-877-295-0720 2. 1-877-295-0720 UMR Care Management 8:00 6:00 1-877-295-0720 2
$150,000 ( ) $750 () $1,500 () () 80% 50% $150,000 $2,500 / $7,500 () 100% $150,000 UnitedHealthcare Choice Plus PA = = PA X () ( PA ) 48 96 () PA 50% 50% PA PA PA PA 3 PA 30 PA 3
( 9 ) PA 50% 50% PA X PA PA PA ( ) ( PA $1,170 $3,000) 6 X PA 72 80% PA 80 % 80 % X PA PA PA X PA UnitedHealthcare ( $10,000 )( ) UnitedHealthcare 31 $50 90 UnitedHealthcare $25 1 $50 2 $75 3 $50 1 $100 2 $150 3 4
40 ( 9 ) PA / $30 80% 80% 80% 80% ( ) 80% 80% / $1,250 9 100 PA PA 80% 80% $4,000 12 4 / $25 PA / $600 PA (CT) / (MRI) PA PA 1) 2) 3) 4) 5) PA 5
PA 80% 80% PA 80% 80% ( ) PA ( 6 ) PA 6 7 18 B PA ( A B 10 ) PA 80% 80% UCLA (525-9) $150,000 UnitedHealthcare (PDL) UnitedHealthcare ( 31 ) PDL UnitedHealthcare StudentResources PDL www.uhcsr.com/ucla 800-980-4698 $50 1 $25 31 2 $50 31 3 $75 31 $10,000 2 90 $50 www.uhcsr.com/ucla 800-980-4698 UnitedHealthcare * Ashe www.studenthealth.ucla.edu UnitedHealthcare 6
* * SHIP 90 http://www.studenthealth.ucla.edu (Insurance) SHIP (SHIP Student Rx Mail Order Program) Medco www.365wellst.com (Getting Started with Mail Order) ( ) Medco / Medco by Mail * Medco, PO Box 747000, Cincinnati, OH 45274-7000 ( ) ( UnitedHealthcare Insurance Company ) * Medco, PO Box 747000, Cincinnati, OH 45274-7000 (877) 417-7345 www.366wellst.com. ( ) 14 (877) 417-7345 ( (800) 759-1089) UnitedHealthcare 24 UnitedHealthcare Choice Plus 1-800-980-4698 www.uhcsr.com/ucla ( ) 50 800-980-4698 UnitedHealthcare Choice Plus 7
PPO 1) 2) (HCG) RH A (PAPPA) () (hcg) () B HBsAg RPR HIV HIV-ab ( ) (AFP) hcg (AFP) hcg a 35 (CVS) 50 ( 1 ) B 1-800-980-4698 $5,000 X X 1. ( ) X 2. X X 3. X 8
$1,250 (1) (2) (1) (2) (3) (4) (1) (2) (3) () (4) (5) (6) (7) (8) (9) (A) (i) (ii) 6 (B) (C) 1 7 26.5 9
AIDS (AIDS) ( ) (1) (2) (3) (4) (5) (6) (7) (8) (9) ( ) (PKU) (PKU) a) b) I II III IV 10
(PSA) 31 30 31 31 1) 2) ( ) 31 1) 2) 3) 4) 1) 2) 3) 4) 5) 6) ( ) 1) 2) 11
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a) b) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. (a) (b) (c) 16. 17. ( ) ( ) ( ) 18. 19. 20. a) b) (Caution - limited by federal law to investigational use) c) d) e) f) Parlodel Pergonal Clomid Profasi Metrodin Serophene g) h) (1) 14
21. / ( ) () 22. 23. 48 96 24. 25. 26. 27. 1-866-704-9660 7 24 Scholastic Emergency Services Scholastic Emergency Services (SES) SES SES Scholastic Emergency Services (SES) SES 100 SES SES 911 SES SES SES * * * * * * * * * * www.uhcsr.com/ucla SES 15
(877) 488-9833 ( ) (609) 452-8570 ( ) medservices@assistamerica.com SES 1. () 2. 3. 4. () 5. 6. SES SES SES www.uhcsr.com/ucla SES SES 1. 2. 3. 30 90 800-980-4698 UnitedHealthcare StudentResources, PO Box 809025, Dallas, TX 75380-9025 800-927-HELP (4357) 213-897-8921California Department of Insurance, Consumer Communications Bureau, 300 South Spring Street, South Tower, Los Angeles, CA 90013 ( ) UnitedHealthcare Insurance Company UnitedHealthcare StudentResources P.O. Box 809025 Dallas, Texas 75380-9025 800-980-4698 customerservice@uhcsr.com claims@uhcsr.com 16
UnitedHealthcare StudentResources www.uhcsr.com (My Account) (My Account) www.uhcsr.com (Create an Account) 7 www.uhcsr.com 2010-525-9 v2 17