Plan Selection
WELCOME
UCLA Scholars
Trail Blazer Elite
starting at
$143.00
per Month
$600,000 Maximum per Covered Accident or Sickness for Scholars
$100,000 Maximum per Covered Accident or Sickness for Insured Dependents
$0 Deductible
Includes Quarantine and Telehealth
Plan Brochure
ISP Custom Trail Blazer Elite 24-25
starting at
$153.00
per Month
$600,000 Maximum per Covered Accident or Sickness for Scholars
$100,000 Maximum per Covered Accident or Sickness for Insured Dependents
$0 Deductible
Includes Quarantine and Telehealth
Plan Brochure
ISP Custom Trail Blazer Elite 25-26
starting at
$153.00
per Month
$600,000 Maximum per Covered Accident or Sickness for Scholars
$100,000 Maximum per Covered Accident or Sickness for Insured Dependents
$0 Deductible
Includes Quarantine and Telehealth
Plan Brochure
UCLA Scholars Custom Trail Blazer Elite
starting at
$153.00
per Month
$600,000 Maximum per Covered Accident or Sickness for Scholars
$100,000 Maximum per Covered Accident or Sickness for Insured Dependents
$0 Deductible
Includes Quarantine and Telehealth
Plan Brochure
HELPFUL QUICK LINKS
USE YOUR INSURANCE
PPO Network
Information about the
Preferred Provider
Organizer
Claims
PPO Network
Information about the
Preferred Provider
Organizer
To find a UHCG PPO provider:
- Go to www.whyuhc.com and click “Search the network for your healthcare provider.”
- Then click “Search the network: Options PPO”.
- Under “What type of medical Care can we help you find near” start by clicking the blue font and entering a street address, city & State, 5 digit zip code or county.
- Once entered, click “Update location“
- You now would enter or select your search parameters by entering a specific providers name, or service in the search box or by clicking one of the categories icons.
Always check with the doctor or medical facility directly to confirm that they accept the UnitedHealthcare Option PPO Network before you receive treatment.
It is best to locate an in-network doctor, urgent care center, and emergency room near you before you get sick.
LINKS
Claims
In most cases, the provider will submit the claim for you.
If you are required to pay for services up front, you will need to complete a claim form in order to be reimbursed by the insurance company.
Download a claim form below, and send the completed form with all bills and receipts for medical treatment to:
Administrative Concepts, Inc.
PO Box 4000
Collegeville PA 19426
Fax: (610) 293-9299
Make sure you fill out the form completely so your claim will be processed promptly.
Keep copies of all the documents you submit for claims. If you have questions about claims, contact Administrative Concepts, Inc.
at (800) 476-4802 or claims@acitpa.com.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.
PPO Network
Information about the
Preferred Provider
Organizer
Claims
Waiver
Criteria
PPO Network
Information about the
Preferred Provider
Organizer
To find a UHCG PPO provider:
- Go to www.whyuhc.com and click “Search the network for your healthcare provider.”
- Then click “Search the network: Options PPO”.
- Under “What type of medical Care can we help you find near” start by clicking the blue font and entering a street address, city & State, 5 digit zip code or county.
- Once entered, click “Update location“
- You now would enter or select your search parameters by entering a specific providers name, or service in the search box or by clicking one of the categories icons.
Always check with the doctor or medical facility directly to confirm that they accept the UnitedHealthcare Option PPO Network before you receive treatment.
It is best to locate an in-network doctor, urgent care center, and emergency room near you before you get sick.
LINKS
Claims
In most cases, the provider will submit the claim for you.
If you are required to pay for services up front, you will need to complete a claim form in order to be reimbursed by the insurance company.
Download a claim form below, and send the completed form with all bills and receipts for medical treatment to:
Administrative Concepts, Inc.
PO Box 4000
Collegeville PA 19426
Fax: (610) 293-9299
Make sure you fill out the form completely so your claim will be processed promptly.
Keep copies of all the documents you submit for claims. If you have questions about claims, contact Administrative Concepts, Inc.
at (800) 476-4802 or claims@acitpa.com.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.
Waiver
Criteria
Waiver Criteria for Opting Out of the School Medical Insurance Plan
If you have other medical insurance, and you do not wish to enroll in the UCLA Scholar Medical Insurance Plan, you may opt out of coverage by submitting a waiver. Your coverage must include all of the following benefits to be eligible to
opt-out:
- $100,000 per accident/illness in medical coverage
- An annual deductible of no more than $500
- Coinsurance that does not exceed 25%
- Medical evacuation up to $50,000
- Repatriation up to $25,000
- Pre-existing conditions must be covered with a waiting period no longer than 12 months
Please be sure to upload your insurance Plan Summary and ID card for evaluation. Your documents will be evaluated to verify your coverage meets the school requirements. Please watch for an email notification of the waiver determination.
PPO Network
Information about the
Preferred Provider
Organizer
Claims
PPO Network
Information about the
Preferred Provider
Organizer
To find a PPO provider by phone, call (800) 226-5116:
- Go to www.myfirsthealth.com and click “Start Now.”
- Select the Type of provider.
- Under “Search by” start by entering your ZIP code and then select a distance.
- (Optional) If you would like to select by specialty, procedure, or other options, click on “Show More Options.”
- Click “Search now.” Select a provider from the generated listing.
- Contact the provider to confirm they accept First Health Network PPO to make an appointment.
Always check with the doctor or medical facility directly to confirm that they accept the UnitedHealthcare Option PPO Network before you receive treatment.
It is best to locate an in-network doctor, urgent care center, and emergency room near you before you get sick.
LINKS
Claims
In most cases, the provider will submit the claim for you.
If you are required to pay for services up front, you will need to complete a claim form in order to be reimbursed by the insurance company.
Download a claim form below, and send the completed form with all bills and receipts for medical treatment to:
Administrative Concepts, Inc.
PO Box 4000
Collegeville PA 19426
Fax: (610) 293-9299
Make sure you fill out the form completely so your claim will be processed promptly.
Keep copies of all the documents you submit for claims. If you have questions about claims, contact Administrative Concepts, Inc.
at (800) 476-4802 or claims@acitpa.com.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.
PPO Network
Information about the
Preferred Provider
Organizer
Claims
PPO Network
Information about the
Preferred Provider
Organizer
To find a PHCS PPO provider, call (800) 678-7427 or visit www.multiplan.com.
- Select “Find a provider.”
- Read about provider information changes and click“OK.”
- Click on “Select a Network”, then select “PHCS.”
- Use the search box to specify what type of provider you are seeking.
- Set your Location by updating your “Zip Code” and “Enter.”
- You may refine your search results as applicable to your needs.
LINKS
PHCS Multiplan Website Claims
In most cases, the provider will submit the claim for you.
If you are required to pay for services up front, you will need to complete a claim form in order to be reimbursed by the insurance company.
Download a claim form below, and send the completed form with all bills and receipts for medical treatment to:
Administrative Concepts, Inc.
PO Box 4000
Collegeville PA 19426
Fax: (610) 293-9299
Make sure you fill out the form completely so your claim will be processed promptly.
Keep copies of all the documents you submit for claims. If you have questions about claims, contact Administrative Concepts, Inc.
at (800) 476-4802 or claims@acitpa.com.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.
Claims
Claims
In most cases, the provider will submit the claim for you.
If you are required to pay for services up front, you will need to complete a claim form in order to be reimbursed by the insurance company.
Download a claim form below, and send the completed form with all bills and receipts for medical treatment to:
Administrative Concepts, Inc.
PO Box 4000
Collegeville PA 19426
Fax: (610) 293-9299
Make sure you fill out the form completely so your claim will be processed promptly.
Keep copies of all the documents you submit for claims. If you have questions about claims, contact Administrative Concepts, Inc.
at (800) 476-4802 or claims@acitpa.com.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.