Resources and Forms

Quick Reference Guides

Forms, Coverage and Benefit Information

Domestic Students

International Students

Other Forms and Coverage Information

For more forms, please visit UnitedHealthcare Resources and Forms.

Frequently Asked Questions

For additional questions, visit the United Healthcare FAQ.

Coverage

The plan selected for University System of Georgia is in the UnitedHealthcare Choice Plus network and is in compliance with the Affordable Care Act (ACA) requirements. These are the “preferred providers” who have contracted to provide specific medical care at negotiated prices.
UnitedHealthcare information is available through My Account 24/7.  Listed below are a few of your benefits. View the entire policy (for domestic or international).

  • Inpatient and Outpatient psychotherapy and alcoholism/drug abuse maximum 30 day visit limit has been eliminated;
  • Ambulance service;
  • Durable medical equipment maximum has been eliminated;
  • Preventative care, well-child care and wellness benefit combined under preventative care, all paid at 100% with no deductible or co-pay.
  • Pharmacy/Prescription drug benefit – Copayment waived for generic prescription medication per 31-day supply; $5 copayment for preferred brand name prescription medication per 31-day supply; $10 copayment for non-preferred brand name. In-Network Coverage Only. Per PPACA, no annual limits except if plan maximum annual limits exceed $100,000.
  • Unlimited medical repatriation and medical evacuation benefits in support of international and domestic travel, except if plan maximum annual limits exceed $100,000.
  • After hour nurse call service and after hour mental health hotline/call service at no additional cost for insured students and family members.
 Coverage begins on August 1 for Fall semester through December 31.  Spring/Summer is January 1 through July 31.
It is limited. Dental is for injury to sound, natural teeth only. Dental benefits are not subject to the $100,000 maximum benefit. Dental does include removal of impacted wisdom teeth. Vision care is covered only as it relates to a disease process. It does not cover eye exams, glasses or contacts.

However, you will have the option to purchase the dental and vision plans separately. These plans will be offered on the UHC website and you will pay UHC directly for these plans. Click here to go to the enrollment page for dental and vision coverage.

No. You may see a healthcare provider of your choosing.  The plan pays 80% for in-­network coverage with UnitedHealthcare Choice Plus managed care provider network and 60% for out-­of-network coverage. If you go to the Student Health Clinic and they determine that you should see another physician, a referral will be provided to you.
It is best practice to contact UnitedHealthcare if you plan to see someone other than your primary care physician to determine if a referral is needed from your primary care physician.
Visit this page to find a list of participating providers in the UHC network. Choose UnitedHealthcare Choice Plus Plan. Click on Change Address and enter your address to get a list of doctors near you.

Eligibility

Insurance plan eligibility is extended to all students enrolled in six (6) or more credit hours per term in a degree-seeking program or who participate in Cooperative Education Programs; AND all graduate and professional students enrolled in at least three (3) graduate level courses in a degree-seeking program, excluding students that are required to enroll in the plan as stated below.

  • All undergraduate and ESL international students holding F or J visas.
  • All undergraduate students enrolled in programs that require proof of health insurance.
  • All graduate students awarded a Full Tuition Waiver as part of their graduate assistantship award.
  • All graduate international students and visiting scholars holding F or J visas.
  • All graduate students enrolled in programs that require proof of health insurance.
  • All graduate students receiving fellowships fully funding their tuition.

Enrollment

Students in the categories listed below are required to purchase the USG SHIP policy and will be billed on their student account for the respective semester and automatically enrolled in the UHSR insurance unless they waive out of the requirement with equivalent insurance.

  • All undergraduate and ESL international students holding F or J visas.
  • All undergraduate students enrolled in programs that require proof of health insurance.
  • All graduate students awarded a Full Tuition Waiver as part of their graduate assistantship award.
  • All graduate international students and visiting scholars holding F or J visas.
  • All graduate students enrolled in programs that require proof of health insurance.
  • All graduate students receiving fellowships fully funding their tuition.

Students who fall into one of these categories and are actively covered by a comparable insurance policy (i.e. through parents plans, family plans or employer-sponsored plans) may opt out of the plan by  applying for a waiver. Once the insurance information has been verified and approved, a waiver will be processed and a credit posted for the insurance charge to your Georgia State University student account. It may require up to 7 days for waiver approval and processing a credit to your student account.

If you are in the mandatory group to have student health insurance, you will be automatically enrolled in the United Healthcare health insurance after the waiver period ends. If proof of insurance is needed quickly, you should activate your enrollment online and print an insurance card.

  1. Check the criteria for the mandatory group. If you do not fall into any of the categories listed, then your name will not appear in the USCSR database and you will receive the message “We were unable to find a student’s record for the submitted information. Please check your information and try again, or contact your school administrator.”
  2. If you are a graduate student awarded a full tuition waiver such as a GRA, GTA, GAA, confirm with your college that a tuition waiver has been applied to your account. Then, contact Student Accounts at 404-­413-­2600 to verify the tuition waiver was posted to your account and that your name has been sent to United Healthcare Student Resources database.
  3. If you fall in one of the remaining categories and receive the message “We were unable to find a student’s record for the submitted information,” email your SHIP representative at ship@gsu.edu.
Insurance charges for students requiring mandatory insurance are posted directly to their student account and payments are made to Georgia State University. Otherwise, students in the non-mandatory group (voluntary) should enroll online using voluntary enrollment form and pay UnitedHealthcare Student Resources directly via credit card or eCheck.
If coverage is purchased for a ‘spring/summer’ period (meaning continuous coverage with no start or stop date for spring and then for summer), no refund will be issued.  You may stay on the plan as long as you meet the eligibility requirements when coverage for spring/summer was purchased.
Mandatory students will need to activate their enrollment online and print a temporary insurance card. You will receive your official insurance card in the mail after the waiver period ends. Activate Enrollment Online

Non-Mandatory (Voluntary) students can access My Account and print their temporary insurance card. Print Temporary Insurance Card 

You will not be charged again for health insurance. UnitedHealthcare will bill Georgia State University for the amount shown on this page. To activate your enrollment, select the checkbox next to: I elect to purchase insurance coverage under this student insurance plan. Above are the choices I have made.* Next, please type first name, middle initial and last name inside Payer Signature box.  Then, click the SUBMIT button. Print Temporary Insurance Card  
If you do not apply for a waiver or if the waiver is declined, you will automatically be enrolled in the plan at the end of the waiver period and you will be mailed an insurance card at that time. The cost of the policy will appear on your student account.

If you need your insurance card prior to the end of the waiver period, you will need to go online and complete the enrollment process yourself. Then, you may print a card immediately and begin using the coverage. Activate enrollment online or print a temporary insurance card.

Typically, you can only enroll in the plan during the designated open enrollment period. The exception to this is if you have a Qualifying Life Event (QLE). To determine acceptable QLEs, contact the University’s SHIP Representatives at ship@gsu.edu.
An insured student who withdraws from school after the first 31 days of the policy period remains enrolled in the plan for the full period for which the premium was paid. In most states, refunds are only made in the case of an insured student entering the U.S. Armed Forces or if eligibility requirements are not met.

Dependents

Dependents can only enroll at the beginning of each respective semester term. However, certain qualifying events allow mandated students and their dependents to enroll outside the end of an enrollment period. Students must elect enrollment within 30 days of the qualifying event.
 Yes, because the arrival of a spouse or child into the country will be considered a qualifying event. You will have 30 days from the date of entry to add the dependent and should pay directly to United Healthcare for spouses and dependents.

Waivers

NOTE: A mandatory health insurance waiver is only valid for one semester, so you will need to submit a new waiver request for each subsequent semester.

UnitedHealthcare Student Resources (UHSR) will verify that the policy you report is in place.  You will need your policy number and name of company and general information about the plan so you can confirm your policy covers the following:

Benefit Requirements for Waivers based on the Affordable Care Act

  • Repatriation of remains in the amount of at least $25,000 (International Only)
  • Medical Evacuation to one’s home country in the amount of at least $50,000 (International Only)
  • Accident and sickness coverage of at least $500,000 per policy year (Domestic)
  • Accident and sickness coverage of at least $250,000 per policy year (International)
  • A deductible not to exceed $3,000 per accident or illness (Domestic)
  • A deductible not to exceed $500 per accident or illness (International Only)

Find out the dates for each semester. You must be in the “mandatory” group to log into the system which means that you have a full-­time tuition waiver or a F1/J1 visa.
The IIE meets the Department of State (DOS) minimums, but does not meet the USG standard of $250,000 for medical benefits minimum per policy year (DOS $100,000 per accident or illness). Yes. While USG prefers that international visitors meet the published minimum standards listed below, USG will collaborate with the Department of State to ensure USG institutional participation in the Fulbright program. USG schools should share the limits below with their exchange partners and ask that they enroll their visitors in PGH Global or a plan from their home institutions that meets or exceeds the USG minimum standards.
If you answer ‘No’ to the questions above the Student Information section on the Waiver Form, your waiver will get denied.

The University System of Georgia requires students that are waiving out of the mandatory insurance to have health insurance coverage that is comparable to the University Plan and your plan must be active for the entire semester that you are enrolled.

Claims

If the student has University Health Insurance through United Healthcare Student Resources or Blue Cross Blue Shield, and visits the Health Clinic on campus; then the Health Clinic will process claims for United Healthcare Student Resources and claims for Blue Cross Blue Shield. If the student does not have University Health Insurance and visits the health clinic on campus; then the student is responsible for filing the claims with his/her insurance provider. If charges for a claim are mailed directly to the student, the student should contact the creditor to give them the student insurance information so that the creditor can file the claim with the student’s insurance provider. The student can also contact the University’s SHIP Representatives for assistance with a claim at ship@gsu.edu.
Please present your health insurance ID card to the administrator of the doctor’s office, hospital or emergency room. The front of the card usually will have the student’s name, identification number, group number, effective date of coverage, benefit information such as co-pays and deductibles. Your health insurance provider’s mailing address for claims is listed on the back of the card along with their number for filing claims electronically and phone numbers.
It is possible the claim was sent to the wrong address. Providers need to send your claims to UnitedHealthcare Student Resources; P.O. Box 809025; Dallas, Texas 75380-9025. If they file electronically, the electronic payer ID is through Emdeon and it’s 74227.
Yes. Some instances may include:

  1. services not covered according to the exclusions listed in the student health insurance plan document. Exclusions and limitations are found on page 3 & 4 of your summary of benefits for Student Injury and Sickness Plan. Please review carefully.
  2. the claim may not have occurred while you were covered. A letter of explanation of benefits from UHC will accompany any denials of claims and any claims paid.
Additional information on claims, enrolling, and using the UHC plan can be found in the Frequently Asked Questions section on United Healthcare’s website.