2013-2014 GTA/GRA/GA Emporia State University www.uhcsr.com/emporia Fort Hays State University www.uhcsr.com/fhsu Kansas State University www.uhcsr.com/k-state Pittsburg State University www.uhcsr.com/pittstate University of Kansas www.uhcsr.com/ku University of Kansas Medical Center www.uhcsr.com/kumc Wichita State University www.uhcsr.com/wichita 12-BR-KS (118-1) (Rev 05-13) 15-200118-1
UnitedHealthcare Insurance Company 2012 9 23 $125 2012 9 23 2014 1 1 $200 2012 9 23 $100,000 2012 9 23 2014 1 1 $500,000 $500,000 1-888-344-6104 26
... 1... 1... 1... 2... 2... 2... 2... 2... 3... 4... 7... 7... 8... 9... 10... 10 X... 10... 10... 10... 10... 11... 11... 14 FrontierMEDEX... 15... 16... 17... 17 UnitedHealth Allies... 17... 17... 17... 19... 19... 20
Kansas Board of Regents (KBOR) Regents Institutions of the State of Kansas UnitedHealthcare Insurance Company UnitedHealthcare StudentResources UnitedHealthcare Choice Plus Network Mount Carmel Regional Medical Center Pittsburg State University 1-888-344-6104 UnitedHealthcare StudentResources 1-888-344-6104 www.uhcsr.com ( ) 6 ( 3 ) / 3 / 50% ( ) ( ) www.uhcsr.com F-1 J-1 31 26 30 1
Kansas Board of Regents (KBOR) 2013 8 1 12:01 2014 7 31 11:59 www.kansasregents.org 2013 8 1 2014 7 31 / () 8 1 1-888-344-6104 F-1 J-1 Fort Hays State University of Kansas Kansas State University Wichita State Pittsburg State www.uhcsr.com UnitedHealthcare StudentResources, P.O. Box 809026, Dallas, TX 75380-9026 8 1 31 2013 8 1 8 31 2013 8 1 30 ( ) 2
Emporia State University www.emporia.edu/shc/ 620-341-5223 Fort Hays State University www.fhsu.edu/studenthealth/ 785-628-4293 Kansas State University www.k-state.edu/lafene/ 785-532-6544 Pittsburg State University www.pittstate.edu/health/ 620-235-4452 University of Kansas www.studenthealth.ku.edu/ 785-864-9500 University of Kansas Medical Center www.kumc.edu/studentcenter/health.html 913-588-1941 Wichita State University www.wichita.edu/shs 316-978-3620 UnitedHealthcare 1. 1-877-295-0720 2. 1-877-295-0720 UnitedHealthcare 8:00 6:00 1-877-295-0720 3
$500,000 ( ) ( ) $300 ( ) ( ) $600 ( ) ( ) 80% 60% $10,000 () $20,000 () UnitedHealthcare Choice Plus Mount Carmel Regional Medical Center Pittsburg State University 100% $500,000 FAIR Health, Inc. 80 100% X $5 ( ) PA = () X ( X ) ( ) 48 96 4 U&C = PA 80% U&C 60% PA 80% U&C 60%
PA 80% U&C 60% 50% 50% PA 80% U&C 60% PA 80% U&C 60% PA 80% U&C 60% PA 80% U&C 60% 3 PA 80% U&C 60% PA 80% U&C 60% 50% 50% PA 80% U&C 60% X PA 80% U&C 60% PA 80% U&C 60% PA 100% / U&C 60% $25 1) 2) 3) 4) 5) 12 PA 80% U&C 60% 72 ( / )( / ) 5 PA 80% / $100 U&C 80% / $100 X X PA 80% U&C 60% ( X 100% / $5 ) PA 80% U&C 60% PA 80% U&C 60% PA 80% U&C 60%
X ( 100% / $5 ) PA 80% U&C 60% PA 80% U&C 60% () $5 / 30% UnitedHealthcare (UHCP) 1 $15 / 2 30% 31 $20 / 40% 31 PA 80% U&C 60% PA 80% U&C 60% ( $1,000) ( $1,000 $500,000 ) PA 80% U&C 60% ( $100) ( $500,000 ) U&C 80% U&C 60% 48 96 6
1) 2) / 1) AB 2) 3) 4) FrontierMEDEX PA 100% 100% $5 30% UnitedHealthcare UnitedHealthcare (PDL) ( ) PDL ( ) / PDL www.uhcsr.com 1-855-828-7716 1 $15 31 2 30% 31 7
www.uhcsr.com 1-855-828-7716 UnitedHealthcare StudentResources, PO.Box 809025, Dallas, TX 75380-9025 UnitedHealthcare www.uhcsr.com 1-855-828-7716 1. () 2. ( ) 3. 2 4. () 5. () www.uhcsr.com 1-855-828-7716 UnitedHealthcare Choice Plus Mount Carmel Regional Medical Center Pittsburg State University 1-888-344-6104 ( ) 8
40 UnitedHealthcare Choice Plus United Behavioral Health (UBH) 1-888-344-6104 (HCG) Rh A (PAPPA) ( ) (hcg) ( ) B HBsAg RPR HIV HIV-ab () (AFP) hcg (AFP) hcg a 35 (CVS) 50 ( 1 ) B 9
1-888-344-6104 X X (1) (2) (3) 1. 2. 3. I II III IV (1) (2) (3) (4) (5) 10
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9 63 15. 16. a) b) c) (Caution - limited by federal law to investigational use) d) e) f) g) Parlodel Pergonal Clomid Profasi Metrodin Serophene Viagra h) i) (1) 17. / ( ) ( ) 18. 19. 20. 21. ( ) 22. 23. 24. ( ) FrontierMEDEX FrontierMEDEX FrontierMEDEX 100 FronteirMEDEX FrontierMEDEX 911 FrontierMEDEX FrontierMEDEX 15
* * * * * * / * * * * * * * * * * * * * * * www.uhcsr.com/frontiermedex FrontierMEDEX (800) 527-0218 ( ) (410) 453-6330 () operations@frontiermedex.com FrontierMEDEX 1. ( ) 2. FrontierMEDEX 3. 4. () 5. 6. FrontierMEDEX FrontierMEDEX FrontierMEDEX www.uhcsr.com/myaccount (MyAccount) FrontierMEDEX 90 1) 2) 1) 2) 16
60 5 UnitedHealthcare StudentResources www.uhcsr.com/myaccount (My Account) (create My Account Now) 7 UnitedHealthcare StudentResources (Message Center) (My Email Preferences) my.uhcsr.com UnitedHealth Allies UnitedHealth Allies UnitedHealth Allies (UnitedHealth Allies Plan) UnitedHealth Allies UnitedHealth Allies UnitedHealth Group UnitedHealth Allies 24 / 180 1. 2. ( ) 3. 4. / 5. 6. 17
1-888-344-6104 Claims Appeals, UnitedHealthcare StudentResources, PO Box 809025, Dallas, TX 75380-9025 1. 2. 888-315-0447 UnitedHealthcare StudentResources, PO Box 809025, Dallas, TX 75380-9025 1. 2. 120 1. a. b. 2. a. b. Kansas Insurance Department Consumer Assistance 420 S.W. 9th Street Topeka, KS 66612 800-432-2484 785-296-3071 Commissioner@ksinsurance.org 18
888-344-6104 Kansas Insurance Department Consumer Assistance 420 S.W. 9th Street Topeka, KS 66612 800-432-2484 785-296-3071 Commissioner@ksinsurance.org www.ksinsurance.org 1) 2) 3) 4) GTA/GRA/GA 2013-200118-1 / A. $ 1,285.00 $ 536.00 $ 536.00 $ 747.00 $ 213.00 B. $ 6,440.00 $ 2,683.00 $ 2,683.00 $ 3,741.00 $ 1,074.00 C. $ 5,733.00 $ 2,389.00 $ 2,389.00 $ 3,330.00 $ 955.00 D. $10,888.00 $ 4,536.00 $ 4,536.00 $ 6,324.00 $ 1,816.00 08-01-2013 07-31-2014 08-01-2013 12-31-2014 01-01-2014 05-31-2014 / 01-01-2014 07-31-2014 06-01-2014 07-31-2014 www.uhcsr.com/kbor (Enroll Now) UnitedHealthcare StudentResources UnitedHealthcare StudentResources, PO Box 809026, Dallas TX 75380-9026 19
1) 2) 3) 30 90 UnitedHealthcare StudentResources P.O. Box 809025 Dallas, Texas 75380-9025 1-888-344-6104 customerservice@uhcsr.com claims@uhcsr.com UnitedHealthcare Insurance Company Kansas Board of Regents (KBOR) www.kansasregents.org 2013-200118-1 v7