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.

If your medical provider hasn’t submitted your claim information to the claims administrator, don't worry. 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 (XL Catlin, Chubb, UnitedHealthcare or IMG). 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

ISP Trail Blazer or Pioneer Elite Plans (for member id #'s beginning with an S)

Submit Medical Claim Forms to Relation Insurance Services:

Relation Insurance Services
PO Box 25936
Overland Park, KS 66225
Phone: 888-388-0931

Online Account:  www.myaccount.coverage2u.com

Medical Claim Form

 

ISP Trail Blazer, Mountaineer or Pioneer Elite Plans (for member id #'s starting with 4 letters) 

Submit Medical Claim Forms to:

Administrative Concepts, Inc.
994 Old Eagle School Rd Suite 1005
Wayne, PA 19087
Phone: 888-293-9229

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

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

Chubb Medical Claim Form

XL Catlin Medical Claim Form

ISP Essential, ISP Basic, ISP Plus and ISP Elite Plans.

Submit Medical Claim Forms to UnitedHealthcare:

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

Email: SI.DRG@uhcsr.com UnitedHealthcare Medical Claim Form

IMG Patriot, Patriot Exchange and Student Health Advantage.

Submit Medical Claim Forms to IMG:

International Medical Group
Claims Department
PO Box 88500
Indianapolis, IN 46208-0500
Phone: 800-628-4664

Email: insurance@imglobal.com

IMG Claim Form

Submit a Prescription Reimbursement Claim

(For all members enrolled in the ISP Trail Blazer, Pioneer Elite and Mountaineer Plans and have a member id # beginning with 4 letters)

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 Elite 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