2023-733-1 Summary Brochure
2023-733-1 Summary Brochure
2023-733-1 Summary Brochure
Graduate students if they are enrolled in a graduate degree or certificate program and taking at least three units or one
dissertation/thesis unit.
Graduate non-degree students must have applied to a degree program and be taking at least six transferable units, be in a
certificate program, or be a full-time student taking at least nine units.
Graduate assistants or associates who are officially hired, with a signed and filed notice of appointment, and taking at least
six units of graduate credit.
Post-Doctoral Fellows, J-1 Visiting Scholars, or J-1 Student Interns are eligible to enroll in this insurance Plan
International students on non-immigrant visas, regardless of his or her fitting into one of the above classifications and
regardless of the number of units being taken, are automatically enrolled in the Plan.
The student (Named Insured, as defined in the Certificate) must actively attend classes for at least the first 31 days after
the date for which coverage is purchased. Home study, correspondence, and online courses do not fulfill the eligibility
requirements that the student actively attend classes. The Company maintains its right to investigate eligibility or student
status and attendance records to verify that the Policy eligibility requirements have been met. If and whenever the Company
discovers that the Policy eligibility requirements have not been met, its only obligation is refund of premium.
Medicare Eligibility
Any person who has Medicare at the time of enrollment in this student insurance plan is not eligible for coverage under the
Master Policy.
If an Insured Person obtains Medicare after the Insured Person is covered under the Master Policy, the Insured Person’s
coverage will not end due to obtaining Medicare.
As used here, “has Medicare” means that an individual is entitled to benefits under Part A (receiving free Part A) or enrolled
in Part B or Premium Part A.
If you do not enroll yourself when you first qualify for medical benefits, you may have to wait until the next enrollment period
to join.
We must receive your completed enrollment information from you within 31 days of that date on which you no longer have
the other coverage mentioned above.
During “Open Enrollment”, notices are sent by broadcast email in compliance with Arizona State University email policy.
These notices go to the student’s official Arizona State University email address.
Auto-Enrollment: Once enrolled, you will be automatically re-enrolled and billed the appropriate premium through the ASU
Bursar’s Office in future semesters (each fall and spring) upon registering for units, providing you meet eligibility. This also
applies to students who have or had a graduate assistantship. If you wish to cancel coverage, you must do so during the
published open enrollment. All open enrollment notices and information regarding the Student Health Insurance Plan are
sent to the student’s official Arizona State University address. The ASU Campus Health Insurance Office notifies students
who are not meeting eligibility requirements through their official ASU email address.
The Insured Person must meet the eligibility requirements each time a premium payment is made. To avoid a lapse in
coverage, the Insured Person’s premium must be received within 31 days after the coverage expiration date. It is the Insured
Person’s responsibility to make timely premium payments to avoid a lapse in coverage.
Student Health Center Referral Required: This plan includes a Student Health Center Referral Requirement.
When you need care, make one of the ASU Health Services or Counseling Services locations your first stop. They can
provide many of the routine health services you need. If you need care they can’t provide, they’ll refer you to a Physician
or other health care provider who belongs to UnitedHealthcare’s Choice Plus network.
A referral from the ASU Health Services or Counseling Services is not necessary only under any of the following
conditions:
Medical Emergency. (You must return to SHC for necessary follow-up care.)
When the Student Health Center is closed.
Medical care received when you are more than 50 miles from the Tempe campus. (Upon return to the Tempe
campus, you must return to ASU Health Services for necessary follow-up care.)
Maternity, obstetrical and gynecological care.
Urgent care expenses. (All follow-up treatment must be obtained through ASU Health Services.)
Adult vision eye exam.
Preventive Care Services. (Services considered to be preventive according to Health Care Reform.)
Routine Physicals / Well Visits.
Prostate Screening.
Impacted wisdom teeth.
Accidental Injury to sound, natural teeth.
Voluntary sterilization for males.
A referral issued by ASU Health Services or Counseling Services must be submitted prior to treatment. Only one referral
is required for each Injury or Sickness per Policy Year. You are responsible for renewing a referral at the beginning of
each Policy Year, if continued care is needed during that Policy Year.
If a referral is not obtained, benefits will be reduced and paid at the Out-of-Network Provider benefit level.
International Students: you are eligible to receive UnitedHealthcare Global services worldwide, except in your home country.
Domestic Students: you are eligible for UnitedHealthcare Global services when 100 miles or more away from your campus
address or 100 miles or more away from your permanent home address or while participating in a Study Abroad program.
The Assistance and Evacuation Benefits and related services are not meant to be used in lieu of or replace local emergency
services such as an ambulance requested through emergency 911 telephone assistance. All services must be arranged
and provided by UnitedHealthcare Global; any services not arranged by UnitedHealthcare Global will not be
considered for payment. If the condition is an emergency, you should go immediately to the nearest physician or hospital
without delay and then contact the 24-hour Emergency Response Center. UnitedHealthcare Global will then take the
appropriate action to assist you and monitor your care until the situation is resolved.
Also includes additional assistance services to support your medical needs while away from home or campus. Check your
certificate of coverage for details, descriptions and program exclusions and limitations.
To access services please refer to the phone number on your ID Card or access My Account and select My
Benefits/Additional Benefits/UHC Global Emergency Services.
When calling the UnitedHealthcare Global Operations Center, please be prepared to provide:
Caller's name, telephone and (if possible) fax number, and relationship to the patient;
Patient's name, age, sex, and UnitedHealthcare Global ID Number as listed on the back of your Medical ID
Card;
Description of the patient's condition;
Name, location, and telephone number of hospital, if applicable;
Name and telephone number of the attending physician; and
Information of where the physician can be immediately reached.
All medical expenses related to hospitalization and treatment costs incurred should be submitted to UnitedHealthcare
Insurance Company for consideration and are subject to all Policy benefits, provisions, limitations, and exclusions. All
assistance and evacuation benefits and related services must be arranged and provided by UnitedHealthcare Global.
Claims for reimbursement of services not provided by UnitedHealthcare Global will not be accepted. A full
description of the benefits, services, exclusions and limitations may be found in your certificate of coverage.
This service is meant to complement your Student Health Center. If possible, we encourage you to visit your SHC first
before using this service.
HealthiestYou is not health insurance. HealthiestYou is designed to complement, and not replace, the care you receive from
your primary care physician. HealthiestYou physicians are an independent network of doctors who advise, diagnose, and
prescribe at their own discretion. HealthiestYou physicians provide cross coverage and operate subject to state regulations.
Physicians in the independent network do not prescribe DEA controlled substances, non-therapeutic drugs and certain other
drugs which may be harmful because of their potential for abuse. HealthiestYou does not guarantee that a prescription will
be written. Services may vary by state.
*Available to Insured students; age restrictions may apply. If you call prior to the effective date of your coverage under the
insurance plan, you will be charged a service fee before being connected to a board-certified physician.
When you sign up, you’ll complete a questionnaire, choose your provider and select a date and time for your appointment.
Appointments are available 7 days a week. Visits are secure, discreet and confidential, and you have ongoing support with
the same provider.
*Available to Insured students; age restrictions may apply, depending on your state.
24/7 StudentAssist
Insureds have immediate access to StudentAssist, a service that coordinates care using a network of resources. Services
available include:
24/7 Crisis & Counseling Support – counseling services are offered by Master’s Licensed Clinicians who can
provide insureds with someone to talk to when everyday issues become overwhelming
Financial and Legal Counseling – two 30 minute telephonic consultations with money coaches who offer
consultations on issues such as financial planning, credit and collection issues, home buying and renting and
more. Legal Services are provided by licensed state-specific attorneys. One 30 minute telephonic or face-to-face
legal consultation per issue per year at no cost.
Mediation services – one 30 minute telephonic or face-to-face consultation per issue per year available to help
resolve family-related disputes, including but not limited to separation, child custody, child support, divorce
property and debt division, etc.
Living Well Portal – access to liveandworkwell.com where insureds can participate in personalized self-help
programs and find information on many helpful resources.
CollegeLife – direct access to experts on the Optum team and through referrals to a broad spectrum of pre-
screened and qualified convenience resources.
Self Care – access to an evidence-based mobile care solution created by clinical experts that allows insureds to
access on-demand help for stress, anxiety, and depression.
Translation services are available in over 170 languages for most services. More information about these services is
available by logging into My Account at www.uhcsr.com/MyAccount under Additional Benefits.
NOTE: The information contained herein is a summary of certain benefits which are offered under a student health insurance
policy issued by UnitedHealthcare. This document is a summary only and may not contain a full or complete recitation of
the benefits and restrictions/exclusions associated with the relevant policy of insurance. This document is not an insurance
policy document and your receipt of this document does not constitute the issuance or delivery of a policy of insurance.
Neither you nor UnitedHealthcare has any rights or responsibilities associated with your receipt of this document. Changes
in federal, state or other applicable legislation or regulation or changes in Plan design required by the applicable state
regulatory authority may result in differences between this summary and the actual policy of insurance.
UnitedHealthcare Student Resources does not treat members differently because of sex, age, race, color, disability or
national origin.
If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a
complaint to:
You must send the written complaint within 60 days of when you found out about it. A decision will be sent to you within 30
days. If you disagree with the decision, you have 15 days to ask us to look at it again.
If you need help with your complaint, please call the toll-free member phone number listed on your health plan ID card,
Monday through Friday, 8 a.m. to 8 p.m. ET.
You can also file a complaint with the U.S. Dept. of Health and Human Services.
Online https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue, SW
Room 509F, HHH Building Washington, D.C. 20201
We also provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you
can ask for free language services such as speaking with an interpreter. To ask for help, please call the toll-free member
phone number listed on your health plan ID card, Monday through Friday, 8 a.m. to 8 p.m. ET.
NDLAP-FO-001 (2-23)