The W&M Student Insurance is an Injury and Sickness Plan underwritten by the UnitedHealthcare Insurance Company and administered by UnitedHealthcare StudentResources (UHCSR). Although, StudentResources is part of UnitedHealthcare, we are a standalone division dedicated to serving the student health insurance market. UHCSR has our own dedicated plan administration office, our own claims submission address and/or electronic payer number. UnitedHealthcare StudentResources has a fully staffed plan administration office that exclusively services this market.
All inquiries, questions and appeals regarding claims, benefits and eligibility MUST be directed to UnitedHealthcare StudentResources. If you are experiencing problems with eligibility verification and/or claims delays, please review the back of the student's insurance card for the correct contact and claims submission information. Reviewing the patient's insurance card is critical to receiving timely and accurate payments. Claims submitted to a UHC plan administration office other than StudentResources will be rejected because the insured student will not be identified in their system.
Providers should use the phone number listed on the back of the patient's insurance card. You can also contact UnitedHealthcare StudentResources (UHCSR) Customer Service by calling (800) 767-0700 Monday through Friday, 7:00 AM to 7:00 PM Central Time or you may email firstname.lastname@example.org.
Providers should submit claims to the company within 90 days after the date of service. Please mail all medical and hospital bills along with the insured student's name and patient's name (if different), the insured's unique 7-digit StudentResources ID number, address and the university's policy number and group name to:
P.O. Box 809025
Dallas, Texas 75380-9025
For electronic submissions, claims should be submitted using Electronic Payer ID#74227.
For Hospital pre-admission notification, call UnitedHealthcare at 1-877-295-0720 Monday through Friday, 8:00 AM to 6:00 PM Central time. Failure to follow notification procedures will not affect benefits otherwise payable under the policy; however pre-notification is not a guarantee that benefits will be paid.
The following is a brief overview of the W&M Student Injury and Sickness plan benefits for billing purposes only. It is not intended to be a guarantee of payment nor does it provide complete details of the coverage including costs, benefits, exclusions, any reductions or limitations and the terms under which the policy may be continued in force.
- The Preferred Provider for this plan is UHC Options PPO but a Student Health Center (SHC) Referral is required for outside care UNLESS it is a medical emergency; the SHC is closed; the service is rendered at a facility that is more than 10 miles from campus or if the student isn't eligible to use the services of SHC due to a change in student status such as when the student is less than full-time, has graduated, no longer an active student or no longer a full-time student.
- Deductible: $150; additional Inpatient Deductible: $250; all deductibles are per insured person, per policy year. There is not a separate deductible for Prescription Drugs.
- Coinsurance: PPO - 20%; Out-of-Network - 50% (except as noted in the Schedule of Benefits in the Plan Certificate)
- PPO Copays (not subject to Deductible unless otherwise stated): Physician's Office Visit - $25; Urgent Care - $20; Medical Emergency expenses - $100; Mental Health Office Visit - $20; Preventive Care Services - $0; Rx - $30 / $60 / 25% each for up to a 31-day supply; Physiotherapy - $20 (plus Preferred Allowance)
- Out-of-Network Copays: Physician's Office Visit - $25 + 30% of U&C; Urgent Care - $20 + 30% of U&C; Medical Emergency expenses - $100 (may be balanced billed by other Out-of-Network Providers like Radiology); Mental Health Office Visit - $20 + 30% of U&C; Preventive Care Services - No benefits; Rx - No benefits; Physiotherapy - $20 + 20% of U&C (12 visits/injury before review of Medical Necessity performed.)
- Limited benefit for one (1) Routine Adult Vision examination and eyeglasses per policy year paid at 80% with Preferred Providers and 50% with Out-of-Network Providers after $150 Policy Deductible; no benefits for contact lens fitting or contact lenses. This benefit is separate from and does not apply to Pediatric Vision Services.
- Limited benefit for one (1) Adult Dental Examination per policy year (subject to the $150 Policy Deductible and 20% of U&C coinsurance); examination includes the Periodic Oral Evaluation, Preventive Prophylaxis (cleaning) and bite-wing diagnostic radiographs (x-rays). This benefit is separate from and does not apply to Pediatric Dental Services.
The W&M Injury and Sickness Insurance Plan covers Preventive Care Services as required by the Affordable Care Act with No Deductible, Copays or Coinsurance applied when the services are received from a Preferred Provider. Medical services, including routine physical examinations, routine testing, preventive testing or treatment and screening exams or testing in the absence of Injury or Sickness, have been approved to have a beneficial effect on health outcomes and are limited to the following as required under applicable law:
- Evidence-based items or services that have in effect a rating of "A" or "B" in the current recommendations of the US Preventive Services Task Force.
- Immunizations that have in effect a recommendation from the Advisory Committee on Immunizations Practices of the Centers for Disease Control and Prevention.
- With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines support by the Health Resources and Services Administration.
- With respect to women, such additional preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration. (see http://www.hrsa.gov/womensguidelines)
- Benefits include FDA-approved contraceptive drugs and devices and office visits associated with contraceptive management.
Please visit www.healthcare.gov/preventive-care-benefits/ for a complete list of services provided for specific age and risk groups. You should also review the Plan Certificate for the complete Schedule of Benefits and the full Exclusions and Limitations list.