Q.Is the Universal One plan considered Major Medical Coverage?
A.No, the Universal One plan includes fixed indemnity benefits and discounts with participating providers. This is not basic health insurance
or major medical coverage and is not a substitute for either. Universal One may act as a complement to comprehensive or major medical insurance.
It contains specific dollar limits that will be paid for medical services which may not be exceeded. The dollar amounts are listed
Q.Does my plan pay for any hospital or physician office visit?
A.Yes. You may visit any hospital or physician. You will receive up to three physician office visits per year,
and the benefit pays $150 per visit. (Concentra Medical Centers in Texas will accept the $150 visit benefit as payment in full
for ALL urgent care related services rendered in-house during your visit.)
Q.Are dependents eligible for the Universal One plan? Who is considered an eligible dependent?
A.Absolutely. We encourage you and your family to sign up in the plan. Eligible dependents include spouses, if not legally
separated or divorced, and children up to age 26. Dependents must be under age 70 and reside in the US. Dependents will only be
enrolled when you elect dependent coverage.
Q.What is a PPO network, and how can I benefit?
A.PPO is the abbreviation for Preferred Provider Organization. This organization of providers (referred to as a “network”)
has agreed to provide their services at a pre-negotiated discount which reduces your out of pocket cost.
Although your plan may be used at any hospital or physician office, members are encouraged to utilize the
PPO network for discounted provider services.
How can I determine which providers participate in the Multiplan Network?
A.You may visit www.uhb1.com and select the "Provider Search"
and "Multiplan Providers" tab, or click here
to locate a network provider near you.
Q.Is there a pre-existing condition exclusion in the medical benefit?
A.No, you may begin using your benefits immediately upon activation.
Q.Are Medicare and Medicaid recipients eligible for the plan?
A.Yes. Having this coverage may interfere with your eligibility qualifications therefore,
we suggest keeping you and your family enrolled in those programs as long as you/they qualify.
Q.May I use the plan if I have comprehensive health insurance coverage?
A.Yes, this plan will pay in addition to any other coverage you have.
Q.Am I eligible for chiropractic visits under this plan?
A.Yes, chiropractic visits are covered under the benefit of a physician office visit.
Q.Am I eligible for maternity visits under this plan?
A.Yes, maternity visits are covered under the benefit of a physician office visit.
Q.How do I file claims?
A.At the time of your medical visit, present your Universal Benefits Card to the provider.
The back of your card has all necessary information for your provider to verify benefits and file a claim.
Your provider may request payment at the time of service; therefore,
you will need to keep a copy of your invoice and submit a claim for reimbursement up to the maximum benefitsuggested in the Universal One plan.
Click here for claim form. Once you have completed, mail
the claim form and copy of your provider invoice to TCC of South Carolina, PO Box 22557,
Charleston, South Carolina, 29413. For question regarding your claim, please contact UHB Member Services at 855.690.7700.
(Do we want to go ahead and provide claims number instead?)
Exclusive Concentra Benefit: (Benefits are subject to change at any time with or without notice. Benefit may only be applied to
a Concentra Clinic in the state of Texas.)
Q.How do I use my Concentra benefit? May I go to Concentra after my 3 office visits have been used?
A.When you visit a Concentra Medical Center within the state of Texas, you will provide them your Universal Benefits Card.
Concentra will then verify you are eligible to receive one of the three office visits included in your plan.
All urgent care related service rendered in-house during your visit are covered 100% under the physician office benefit and paid for
by the insurance company. Once you have exceeded your three office visits, you will be referred to Concentra’s
Cash Pay Pricing and assume financial responsibility for the cost of the services rendered. For Cash Pay Pricing,
Q.Will my dependents be able to use the Concentra office visit benefit?
A.Yes. Once you have enrolled dependents in the Universal One plan, they will receive the same benefits.
Q.Are my dependents eligible for pediatric visits under this plan?
A.Yes, pediatric visits are covered under the benefit of a physician office visit.
***Concentra accepts patients age 3 and up.***
Q.***Concentra accepts patients age 2 and up.***
A.You may visit www.uhb1.com and select the "Provider Search" and "Concentra" tab,
or click here to locate a clinic near you and determine hours of operation
for each location.
Q.WWhat happens if I choose to go outside of the Concentra Network for an office visit?
A.The outpatient physician office visit benefit pays $150 three times per calendar year. When you choose to be seen at a
Concentra Medical Center in Texas for urgent care related services, your three visits are covered at no additional cost to you.
Should you choose to visit a physician outside of the Concentra network, you will be financially responsible for any charges exceeding $150.
For example, your primary care physician may charge $200 for your visit. You have a $150 office visit benefit with your Universal One plan.
You will now be responsible for the $50 difference.
KARIS ADVOCACY BENEFIT:
Q.When should I contact Karis?
A.YYou may contact Karis once all insurance and network discounts have been applied to a claim.
You will then be assigned an advocate that will negotiate your out of pocket expense and keep you informed of your case until settled.
To begin working with your personal advocate, please contact UHB Member Services at 855.690.7700. (Should we refer to direct Karis line?
Q.Is there a dollar amount that must be met before they will assist in negotiating my out of pocket expense?
A.No. There is a $0 threshold, which means Karis will negotiate any out of pocket expense you may incur.
Q.When should I contact Teladoc?
A.Contact Teladoc when you need more than basic medical advice. A licensed physician is available to take your call 24/7/365. They will assist with treatment plans, recommendations and prescribe non-controlled prescription medication when necessary.
***It is necessary to complete a Medical History Disclosure prior to making your initial call.
Teladoc will keep your information on file for future consultations. You may submit your form by fax, mail or electronically.***
- 1. To submit electronically:
- Visit www.teladoc.com and set up your account.
- A drop-down window will ask if you have been given a username. Select “no” and “continue”.
- Enter your legal first name, last name, date of birth and code: CAREVIP. After completion, select "continue".
- Complete all required fields on the Personal Information and Medical History page. You will "skip" the billing section. You will now review your information and submit with an electronic signature.
- 2. To submit by fax or mail, click , Click here to print form. Complete the form in its entirety and fax or mail to:
- Fax: 972.661.2312 or
- Mail: Teladoc Customer Relations Department
4100 Spring Valley, Suite 515
Dallas, Texas 75244
- 3.You will also receive a benefit package in the mail (fulfillment) including the Medical History Disclosure when your plan is activated. We encourage you to fill out the form immediately and fax or mail to Teladoc Customer Relations Department.
Contact a physician 24 hours a day by calling: 1.800.TELADOC.
***Money Saving Tip***
We understand it’s difficult to leave work when an illness occurs. This will prevent you from missing work and pay while you
receive the treatment you deserve.
Q.Is there a consultation fee associated with my call?
A.There are no additional fees when you follow one of the three steps above.
PRESCRIPTION DRUG DISCOUNT:
Q.How do I use my prescription drug discount card?
A.Simply show your Universal Benefits Card to the pharmacy and receive immediate savings on your prescription purchase. Members may also receive savings on 90 day supplies of medications when ordered online, by phone or through the mail with mail-order pharmacy. For mail-order pharmacy, call 866.744.0621.
***Money Saving Tip***
Ask your provider or pharmacist for generic where applicable. With a generic prescription, your cost is lower and you will receive a greater discount.
Q.Will I have access to a pharmacy locator or prescription price check?
A.Yes, please visit www.uhb1.com and select the "Provider Search" and "Pharmacy Locator" tab, or click here to locate to locate a pharmacy near you and receive access to prescription drug price checks.
Q.How do my discounts work?
A.Please visit www.uhb1.com and select “UHB Plans” for a detailed description of your discounts. You may also locate a Discount Network Provider by clicking here. (Jenn will have link after Careington agreement completion.) Once you have selected a provider and make an appointment, you will show your Universal Benefits Card at the time of service. You will be responsible for paying all discounted fees directly to the provider at the time services are rendered.
Q.What should I say when contacting a Discount Provider to ensure they participate?
A. The provider will recognize the name of the "Careington" network with which they participate; therefore, it is important to use this when making the call.
Q.May I use my discounts when I travel?
A.Yes, you may access discounts at any participating provider in the United States.
Q.How long will it take before I’m able to use my discounts?
A. Once you have enrolled in the plan, you may begin using your discounts upon your first weekly deduction from Universal Health Benefits.
Q.May I go to a provider that does not participate?
A.You may go to the provider of your choice; however, you will only receive a discount by going to a participating provider.
Q.If my doctor refers me to a specialist outside of the network, will I receive a discount?
A. You will only receive a discount by going to a participating provider. You might try printing a list of participating providers to share with your doctor or dentist to see if he/she could recommend any of the participating specialists.
Q.Once I select a provider, am I assigned to that provider? How often can I change providers?
A.With the discount feature, you have the ability to select any provider from the network. You may change providers any time, and household members may select their own providers.