What is a Preferred / In-Network Provider?

A Preferred Provider is a doctor, hospital, or other health care provider that is contracted to participate in a specific network of providers. 

The advantage to using a Preferred Provider is that these providers have agreed to accept a predetermined fee (or “Preferred Allowance”) as payment for their services. When using Preferred Providers, out-of-pocket expenses will be less. 

Note: An insured person should be aware that Preferred Provider hospitals may be staffed with Out-of-Network providers. Receiving services or care from an Out-of-Network provider at a Preferred Provider hospital does not guarantee that all charges will be paid at the Preferred Provider level of benefits.

Click the Find a Doctor box for more information on the specific Preferred Provider Network applicable to your school’s Student Health Insurance Plan.

Network participation is subject to change, so please verify with the provider that they are participating in the network when making an appointment or at the time of service.

The Claims Company is the organization that pays insurance claims on behalf of the insurance company. In some cases, the insurance company and the claims company may be the same organization.

We encourage you to create an account with your insurance plan’s claims company directly on their website, as doing so will allow you to view your claims activity and respond electronically to any requests for information that may be necessary.

In most cases, you will not need to submit a claim for reimbursement directly, as your doctor, pharmacy or other healthcare provider will submit claims directly on your behalf, based on the information provided on your health insurance ID Card. However, if you have paid out of pocket for a claim or did not have your insurance card available, you may need to complete a claim form and submit for reimbursement of amounts you have paid directly.

Click the Claims Company link for more information on the Claims Company that is servicing your School’s Student Health Insurance Plan and important instructions that you may need. 

What is a Preferred / In-Network Provider?

A Preferred Provider is a doctor, hospital, or other health care provider that is contracted to participate in a specific network of providers. 

The advantage to using a Preferred Provider is that these providers have agreed to accept a predetermined fee (or “Preferred Allowance”) as payment for their services. When using Preferred Providers, out-of-pocket expenses will be less. 

Note: An insured person should be aware that Preferred Provider hospitals may be staffed with Out-of-Network providers. Receiving services or care from an Out-of-Network provider at a Preferred Provider hospital does not guarantee that all charges will be paid at the Preferred Provider level of benefits.

Click the Find a Doctor box for more information on the specific Preferred Provider Network applicable to your school’s Student Health Insurance Plan.

Network participation is subject to change, so please verify with the provider that they are participating in the network when making an appointment or at the time of service.

The Claims Company is the organization that pays insurance claims on behalf of the insurance company. In some cases, the insurance company and the claims company may be the same organization.

We encourage you to create an account with your insurance plan’s claims company directly on their website, as doing so will allow you to view your claims activity and respond electronically to any requests for information that may be necessary.

In most cases, you will not need to submit a claim for reimbursement directly, as your doctor, pharmacy or other healthcare provider will submit claims directly on your behalf, based on the information provided on your health insurance ID Card. However, if you have paid out of pocket for a claim or did not have your insurance card available, you may need to complete a claim form and submit for reimbursement of amounts you have paid directly.

Click the Claims Company link for more information on the Claims Company that is servicing your School’s Student Health Insurance Plan and important instructions that you may need.