How to Make a Claim

When you visit your Student Health Center, a doctor’s office, or hospital, provide them with a copy of your insurance ID card. In most cases, the medical provider will submit your claim information directly to the claims administrator. Then, all you will need to do is complete a claim form and return it to the claims administrator. A separate claim form is needed for each accident or sickness.

Don’t worry if your medical provider hasn’t submitted your claim information to the claims administrator. If you have already paid the medical provider for their services you will just need to submit an itemized bill from the medical provider and receipt showing the amount paid, along with a completed claim form, to the claims administrator. Our claims administrator will review the information, and reimburse you for any covered expenses.

For each accident or sickness, you will need to ensure you use the claim form that is appropriate to your insurance provider (Catlin, ACE, or UnitedHealthcare). To find out which insurance provider your plan uses, check your ID card, which indicates the name of the insurance provider.

The easiest way to submit documents and claim forms is through your online account. We encourage you to create an online account to help you manage your plan and claims. If you do not use your online account, we recommend that you email your claim forms and other documents when possible to ensure that there is a record of the date and time the claim was submitted. Alternatively, you can send your claim through fax or regular mail.

Additional information on claims can be found under our FAQ’s page .




 

Submit a Medical Claim

(For all members enrolled in the ISP Trail Blazer, Pioneer Elite, Tourer, Explorer or Pioneer Enriched Plans)

Submit Medical Claim Forms to:

Administrative Concepts, Inc.
994 Old Eagle School Rd
Suite 1005
Wayne, PA 19087

Telephone: 888-293-9229, option #2 for Member Services

Fax: 610-293-9299
Email: aciclaims@visit-aci.com

8:00 AM - 5:00P M in All US Time Zones, Monday - Friday

You can submit and track the status of your claims using your Online Account: Secure Online Account

ACE Medical Claim Form

Catlin Medical Claim Form

(For all members enrolled in the ISP Basic, Plus, Plus Sports or Preferred Plans)

Submit Medical Claim Forms to UnitedHealthcare:

UnitedHealthcare
StudentResources
PO Box 809025 Dallas, TX 75380-9025
Fax: 469-229-5625

8:30 AM - 5:00 PM Eastern Time, Monday – Friday

Email (Recommended): SI.DRG@uhcsr.com

 UnitedHealthcare Medical Claim Form


Submit a Prescription Reimbursement Claim

(For all members enrolled in the ISP Trail Blazer, Pioneer Elite and Mountaineer Plans)

These ISP plans include prescription coverage through Express Scripts which is indicated on your ID card. If your doctor gives you a prescription, you would simply present your ID card to the pharmacy and pay any applicable copay when filling the prescription. If you do not have your ID card with you, or pay for the prescription in full, you will need to submit a claim for reimbursement. Please mail your completed Prescription Reimbursement claim form and receipt(s) to Express Scripts at the following address:

Express Scripts
PO Box 14711
Lexington, KY 40512

ISP Tourer and Explorer plans DO NOT use Express Scripts, you will need to send a copy of your prescription along with your receipt to ACI for reimbursement consideration.Express Scripts RX Claim Form

 

(For all members enrolled in the ISP Basic, Plus, Plus Sports or Preferred Plan)

These ISP plans include prescription coverage through Optum RX which is indicated on your ID card. If your doctor gives you a prescription, you would simply present your ID card to the pharmacy and pay any applicable copay when filling the prescription. If you do not have your ID card with you, or pay for the prescription in full, you will need to submit a claim for reimbursement. Please mail your completed Prescription Reimbursement claim form and receipt(s) to Optum RX at the following address:

OptumRx Claims Department
PO Box 29044
HotSprings, AR 71903

 

Optum RX Claim Form