2023-733-1 Summary Brochure

Download as pdf or txt
Download as pdf or txt
You are on page 1of 11

2023 - 2024 Student Health Insurance Plan for

Arizona State University


Who is eligible to enroll? Grand Canyon University
All Undergraduate students if they are enrolled in a program of study taking six or more units and have a consortium
agreement to take courses at a qualified college with an overall credit hour total of at least six units. Seniors may enroll
with less than six units if they are in their last semester to achieve their final graduation requirements and had the insurance
coverage in the prior semester.

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.

23PPOSBAZ (733-1) Page 1 of 8 UnitedHealthcare Student Resources


Enrollment
When you can join the plan
As a student you can enroll yourself:
 During the enrollment period
 At other special times during the year

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.

Special times you can join the plan


You can enroll in these situations:
 When you did not enroll in this plan before because:
 You were covered by another health plan, and now that other coverage has ended.
 You had COBRA, and now that coverage has ended.
 You become eligible for State premium assistance under Medicaid or an S-CHIP plan for the payment of your premium
contribution for coverage under this plan.
 When you are a victim of domestic abuse or spousal abandonment and you don’t want to be enrolled in the perpetrator’s
health plan.

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.

Where can I get more information about the benefits available?


Please read the certificate of coverage to determine whether this plan is right before you enroll. The certificate of coverage
provides details of the coverage including benefits, exclusions, and reductions or limitations and the terms under which the
coverage may be continued in force. Copies of the certificate of coverage are available from the University and may be
viewed at www.uhcsr.com/ASU. This plan is underwritten by UnitedHealthcare Insurance Company and is based on policy
number 2023-733-1. The Policy is a Non-Renewable One-Year Term Policy.

Who can answer questions I have about the plan?


If you have questions please contact Customer Service at 1-866-652-9185 or customerservice@uhcsr.com.

Highlights of Coverage offered by UnitedHealthcare Student Resources

Coverage Dates and Plan Cost


Annual Fall Spring Summer
Rates 8-16-23 to 8-16-23 to 1-1-24 to 5-16-24 to
8-15-24 12-31-23 8-15-24 8-15-24
Student $2,765.00 $1,043.00 $1,722.00 $695.00

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.

23PPOSBAZ (733-1) Page 2 of 8 UnitedHealthcare Student Resources


Highlights of the Student Health Insurance Plan Benefits
METALLIC LEVEL – PLATINUM WITH AN ACTUARIAL VALUE OF 92.45%
Preferred Providers: The Preferred Provider Network for this plan is UnitedHealthcare Choice Plus. Preferred Providers
can be found using the following link: UHC Choice Plus
Student Health Center Benefits:
 The Deductible and Copays will be waived and benefits will be paid at 100% for Covered Medical Expenses incurred
when treatment is rendered at the Student Health Center for the following services: Travel Immunizations, Well-
Woman Care, Preventive Care, and Initial Counseling Assessment for Psychiatric Services.
 The Deductible will be waived and benefits will be paid at 100% for Covered Medical Expenses incurred when
treatment is rendered at the Student Health Center for the following services:
 Counseling and Psychiatric Services: Brief Counseling Treatment after $15 Copay per visit and Psychiatric
Services after $15 Copay per visit.
 Lab and X-ray after $10 Copay per visit.
 General Medicine after $15 Copay per visit.
 Specialist Care and Chiropractic Care after $25 Copay per day.
 All other services listed in the Schedule of Benefits.
 Benefits will be paid at the Preferred Provider level of benefits for laboratory procedures performed at the SHC and
labs sent to LabCorp or Sonora Quest Laboratories by the SHC. SHC referral is not required.
Arizona State University Health Services Information

ASU Health Services (All Campuses – Tempe/Downtown/Poly/West)


Hours: Monday – Friday, 8 a.m. – 5 p.m.
Phone: 480-965-3349
After hours medical advice: 480-965-3349
Please visit https://eoss.asu.edu/health for more information.

ASU Counseling Services (All Campuses – Tempe/Downtown/Poly/West)


Hours: Monday – Friday, 8 a.m. – 5 p.m.
Phone: 480-965-6146
After hours EMPACT’s 24-hour ASU-dedicated crisis hotline: 480-921-1006
Please visit https://eoss.asu.edu/counseling for more information.

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.

23PPOSBAZ (733-1) Page 3 of 8 UnitedHealthcare Student Resources


To learn more about UnitedHealthcare’s Preferred Providers, visit www.uhcsr.com.
Preferred Providers Out-of-Network Providers
Overall Plan Maximum There is no overall maximum dollar limit on the policy
Plan Deductible $250 Per Insured Person, per $1,000 Per Insured Person, per
Policy Year Policy Year
Out-of-Pocket Maximum $1,500 Per Insured Person, Per $3,000 Per Insured Person, Per
After the Out-of-Pocket Maximum has been Policy Year Policy Year
satisfied, Covered Medical Expenses will be
paid at 100% for the remainder of the Policy
Year subject to any applicable benefit
maximums. Refer to the plan certificate for
details about how the Out-of-Pocket
Maximum applies.
Coinsurance 80% of Allowed Amount for 50% of Allowed Amount for Covered
All benefits are subject to satisfaction of the Covered Medical Expenses Medical Expenses
Deductible, specific benefit limitations,
maximums and Copays as described in the
plan certificate.
Prescription Drugs $125 Deductible (per Policy Year) $125 Deductible (per Policy Year)
UHCP Mail Order Network Pharmacy or does not apply to Policy Deductible does not apply to Policy Deductible
Preferred 90 Day Retail Network Pharmacy $15 Copay for Tier 1 $15 Copay for generic drugs
at 2.5 times the retail Copay up to a 90-day $40 Copay for Tier 2 $40 Copay for brand name drugs
supply. $80 Copay for Tier 3 100% of billed charge
Prescription Drugs and contraceptives Up to a 31-day supply per Up to a 31-day supply per
covered under the Preventive Care Services prescription filled at a prescription
benefit will be paid at the benefit level UnitedHealthcare Pharmacy
shown under Preventive Care Services. (UHCP) Retail Network Pharmacy
Preventive Care Services 100% of Allowed Amount 50% of Allowed Amount
Including but not limited to: annual after Deductible
physicals, GYN exams, routine screenings
and immunizations. No Deductible, Copays,
or Coinsurance will be applied when the
services are received from a Preferred
Provider. Please visit
www.healthcare.gov/preventive-care-
benefits/ for a complete list of the services
provided for specific age and risk groups.
The following services have per service Physician’s Visits: $25 Medical Emergency: $200
Copays not subject to Deductible not subject to Deductible
This list is not all inclusive. Please read the Urgent Care Center: $25 The Copay will be waived if admitted
plan certificate for complete listing of not subject to Deductible to the Hospital.
Copays. Physiotherapy: $25
not subject to Deductible
Medical Emergency: $200
not subject to Deductible
The Copay will be waived if
admitted to the Hospital.
Outpatient Mental Illness/Substance Use Office Visits: Office Visits:
Disorder Treatment, except Medical $25 Copay per visit 50% of Allowed Amount
Emergency and Prescription Drugs 100% of Allowed Amount after Deductible
not subject to Deductible Other Outpatient Services
Other Outpatient Services (including partial hospitalization):
(including partial hospitalization): 50% of Allowed Amount
100% of Allowed Amount after Deductible
not subject to Deductible
Pediatric Dental and Vision Benefits Refer to the plan certificate for details (age limits apply).

23PPOSBAZ (733-1) Page 4 of 8 UnitedHealthcare Student Resources


Exclusions and Limitations
No benefits will be paid for: a) loss or expense caused by, contributed to, or resulting from; or b) treatment, services or
supplies for, at, or related to any of the following:
1. Acupuncture, except as specifically provided in the Policy.
2. Behavioral problems.
This exclusion does not apply as specifically provided in Benefits for Autism Spectrum Disorder.
3. Cosmetic procedures, except as specifically provided in the Policy for the necessary care and treatment of medically
diagnosed Congenital Conditions or reconstructive procedures to correct an Injury or treat a Sickness for which
benefits are otherwise payable under the Policy. The primary result of the procedure is not a changed or improved
physical appearance.
4. Custodial Care.
 Care provided in: rest homes, health resorts, homes for the aged, halfway houses, college infirmaries or places
mainly for domiciliary or Custodial Care.
 Extended care in treatment or substance abuse facilities for domiciliary or Custodial Care.
5. Dental treatment, except:
 For accidental Injury to Sound, Natural Teeth.
 As described under Dental Treatment in the Policy.
This exclusion does not apply to benefits specifically provided in Pediatric Dental Services.
6. Elective Surgery or Elective Treatment.
7. Elective abortion, except when the pregnancy is the result of rape or incest or it places the Insured’s life in serious
danger.
8. Flight in any kind of aircraft, except while riding as a passenger on a regularly scheduled flight of a commercial
airline.
9. Foot care for the following, except as specifically provided in the Policy:
 Flat foot conditions.
 Supportive devices for the foot, except as specified in the Policy.
 Subluxations of the foot.
 Fallen arches.
 Weak feet.
 Chronic foot strain.
 Routine foot care including the care, cutting and removal of corns, calluses, toenails, and bunions (except
capsular or bone surgery).
This exclusion does not apply to preventive foot care due to conditions associated with metabolic, neurologic, or
peripheral vascular disease, or as specifically provided in the Policy.
10. Health spa or similar facilities. Strengthening programs.
11. Hypnosis.
12. Immunizations for work.
13. Injury or Sickness for which benefits are paid or payable under any Workers' Compensation or Occupational
Disease Law or Act, or similar legislation.
14. Injury sustained by reason of a motor vehicle accident to the extent that benefits are paid or payable by any other
valid and collectible insurance.
15. Injury sustained while:
 Participating in any intercollegiate or professional sport, contest or competition.
 Traveling to or from such sport, contest or competition as a participant.
 Participating in any practice or conditioning program for such sport, contest or competition.
16. Lipectomy.
17. Marital or family counseling.
18. Nuclear, chemical or biological Contamination, whether direct or indirect. “Contamination” means the contamination
or poisoning of people by nuclear and/or chemical and/or biological substances which cause Sickness and/or death.
19. Participation in a riot or civil disorder. Commission of or attempt to commit a felony. Fighting.
20. Prescription Drugs, services or supplies as follows, except as specifically provided in the Policy:
 Therapeutic devices or appliances, including: hypodermic needles, syringes, support garments and other non-
medical substances, regardless of intended use, except as specifically provided in the Policy.
 Immunization agents, except as specifically provided in the Policy.
 Drugs labeled, “Caution - limited by federal law to investigational use” or experimental drugs.
 Products used for cosmetic purposes.
 Drugs used to treat or cure baldness. Anabolic steroids used for body building.
 Anorectics - drugs used for the purpose of weight control.
 Fertility agents or sexual enhancement drugs.
 Refills in excess of the number specified or dispensed after one (1) year of date of the prescription.
21. Reproductive services for the following, except as specifically provided in the Policy:
 Genetic counseling and genetic testing.
23PPOSBAZ (733-1) Page 5 of 8 UnitedHealthcare Student Resources
 Cryopreservation of reproductive materials. Storage of reproductive materials.
 Fertility tests, except to diagnose infertility only.
 Infertility treatment (male or female), including any services or supplies rendered for the purpose or with the
intent of inducing conception.
 Premarital examinations.
 Impotence, organic or otherwise.
 Reversal of sterilization procedures.
22. Research or examinations relating to research studies, or any treatment for which the patient or the patient’s
representative must sign an informed consent document identifying the treatment in which the patient is to
participate as a research study or clinical research study, except as specifically provided in the Policy.
23. Routine eye examinations, except vision screening provided during an annual Routine Physical/Well Visit or as
provided in Preventive Care Services. Eye refractions. Eyeglasses. Contact lenses. Prescriptions or fitting of
eyeglasses or contact lenses. Vision correction surgery. Treatment for visual defects and problems.
This exclusion does not apply as follows:
 When due to a covered Injury or disease process.
 To benefits specifically provided in Pediatric Vision Services.
 To benefits specifically provided in the Policy.
 To the initial pair of contact lenses for the treatment of keratoconus or post-cataract surgery.
24. Services provided normally without charge by the Health Service of the Policyholder. Services covered or provided
by the student health fee.
25. Deviated nasal septum, including submucous resection and/or other surgical correction thereof, other than for the
treatment of a Covered Medical Expense. This exclusion does not apply to benefits specifically provided in the
Policy.
26. Skydiving. Parachuting. Hang gliding. Glider flying. Parasailing. Sail planing. Bungee jumping.
27. Naturopathic services.
28. Stand-alone multi-disciplinary smoking cessation programs. These are programs that usually include health care
providers specializing in smoking cessation and may include a psychologist, social worker or other licensed or
certified professional.
29. Supplies, except as specifically provided in the Policy.
30. Surgical breast reduction, breast augmentation, breast implants or breast prosthetic devices, or gynecomastia,
except as specifically provided in the Policy.
31. Treatment in a Government hospital, unless there is a legal obligation for the Insured Person to pay for such
treatment.
32. War or any act of war, declared or undeclared; or while in the armed forces of any country (a pro-rata premium will
be refunded upon request for such period not covered).
33. Weight management. Weight reduction. Nutrition programs, except as specifically provided for in the Policy.
Treatment for obesity, except as specifically provided in the Policy for Bariatric Surgery. Surgery for removal of
excess skin or fat. This exclusion does not apply to benefits specifically provided in the Policy.

UnitedHealthcare Global: Global Emergency Services


If you are a student insured with this insurance plan, you are eligible for UnitedHealthcare Global Emergency Services. The
requirements to receive these services are as follows:

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.

Key Assistance Benefits include:


 Emergency Evacuation
 Dispatch of Doctors/Specialists
 Medical Repatriation
 Transportation After Stabilization
 Transportation to Join a Hospitalized Insured Person
 Return of Minor Children
23PPOSBAZ (733-1) Page 6 of 8 UnitedHealthcare Student Resources
 Repatriation of Remains

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.

Highlights of Services offered by UnitedHealthcare Student Resources

Healthiest You: 24/7 Doctor Access


Starting on the effective date of your coverage under the student insurance plan, you have 24/7 access to medical advice
through HealthiestYou, a national telehealth service.* By visiting www.telehealth4students.com, you have access to board-
certified physicians via phone and/or video, where permitted. This service is especially helpful for minor illnesses, such as
allergies, sore throat, earache, pink eye, etc. Based on the condition being treated, the doctor can also prescribe certain
medications, saving you a trip to the doctor’s office. Using HealthiestYou can save you money and time, while avoiding
costly trips to a doctor’s office, urgent care facility, or emergency room. As an insured with Student Resources, there is no
consultation fee for this service.* Every call with a HealthiestYou doctor is covered 100% during your policy period. You
can learn more about this benefit and how to use it in My Account.

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.

HealthiestYou: Virtual Counselor Access


Starting on the effective date of your coverage under the student insurance plan, you have access to mental health providers
through a national virtual counseling service.* Psychiatrists, psychologists and licensed therapists are available to you
through a variety of communication methods, including phone and video.

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.

23PPOSBAZ (733-1) Page 7 of 8 UnitedHealthcare Student Resources


As an insured with Student Resources, there is no consultation fee for this service. Every communication with a provider is
covered 100% during your policy period.

*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.

This Summary Brochure is based on Policy # 2023-733-1.

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.

23PPOSBAZ (733-1) Page 8 of 8 UnitedHealthcare Student Resources


NON-DISCRIMINATION NOTICE

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:

Civil Rights Coordinator


United HealthCare Civil Rights Grievance
P.O. Box 30608
Salt Lake City, UTAH 84130
UHC_Civil_Rights@uhc.com

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

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Phone: Toll-free 1-800-368-1019, 800-537-7697 (TDD)

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)

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy