Documents

2020-21 Summary Brochures

A summary of policy benefits and exclusions for the 2020-21 plan effective August 1, 2020.


2020-21 Enrollment Form

Application for student health, dental, and/or vision insurance enrollment for students and dependents. Premium information and enrollment deadlines are included on the form. Please reference the bottom of page 2 for submission instructions.

 

2020-21 Plan Certificates

A detailed description of policy benefits and exclusions for the 2020-21 plan effective August 1, 2020.


Network Providers

The student health insurance plan uses the UnitedHealthcare Choice Plus medical and United Behavioral Health mental health network. Click here to browse the provider directories. 

 

Dental Coverage Summary

A detailed listing of benefits and exclusions for the optional dental insurance. Pricing is listed on our Enrollment Form.  To search for an in-network dentist visit www.myuhcdental.com and select the network: National Options PPO 30 or call 888-679-8925 and reference the UT Plan.

 

Vision Coverage Summary

A detailed listing of covered services for the optional vision insurance. Pricing is listed on our Enrollment Form. Visit www.myuhcvision.com or call 800-839-3242 to locate a network provider.

 

Prescription Drug List

A list of commonly prescribed medications divided into copay cost levels. Visit uhcsr.com/pdl, call 1-855-828-7716, or log in to My Account for complete and up-to-date information. 

 

Prescription Claim Form

This claim form can be submitted with a pharmacy receipt for reimbursement of covered prescriptions purchased when/if your ID card is not available.

 

Referral Guide

Contains details on the UT Knoxville Health Clinic referral requirements. You may also contact UT Student Health Service at 865-974-2337. 

 

Personal Representative Appointment Form

This form will allow UHC Student Resources to speak with family members or other parties who may be assisting with claims or benefit questions.

 

Mobile App Flyer

Information on setting up a mobile account for access to your ID card, claims status and help with locating a doctor or pharmacy.

 

UnitedHealthcare Global Services Flyer

Information on services provided to traveling students. Worldwide emergency assistance is available when traveling more than 100 miles away from home.