IHTSC Benefits
IHTSC has two Medical Plans to choose from: H.S.A. Plan or PPO Plan
Network is United Health Care Options PPO
Plan Year (01/01/2018-12/31/2018)
Insurance Information
2018 Benefits Summary Download
Insurance Information
If you have any questions or difficulties, please contact Human Resources Department: Teasha Seibert (317) 471-4459.
How to submit a claim.
Most providers will accept assignment and coordinate payment directly with the Plan on the Covered Person’s behalf. If the provider will not accept assignment or coordinate payment directly with the Plan, then the Covered Person will need to send the claim to the Plan. The address for submitting medical claims is on the back of the group health identification card.
Medical Claims:
UMR, PO Box 30541, Salt Lake City, UT 84130-0541
Payor ID for Electronic Claim Submission: 39026
1. To check claims go to: www.umr.com (register to set-up an account)
2. Find a provider online at www.umr.com
a. Provider network is: United Health Care Options PPO
3. Reminder: Co-pays do not apply to deductible
Prescriptions: Must be a Network Pharmacy
1. To locate a Pharmacy go to: www.umr.com & navigate to the myPharmacyCenter section.
2. You may also call OptumRx at 877-559-2955.
3. Co-pay, Participation or Deductible amount is based whether you visit the Pharmacy or order your medications through mail order, as well as, on your medication’s tier assignment. To check tier level, visit: www.UMR.com & navigate to myPharmacyCenter you may also call OptumRX.
4. Specialty Drugs must be purchased at a Specialty Pharmacy.
5. To locate a Specialty Pharmacy go to: www.umr.com & navigate to the myPharmacyCenter section.
Prescriptions – Mail Order – OptumRx
Address: OptumRx, PO Box 2975, Mission, KS 66201
1. Mail-In order form available in Human Resources or online at www.UMR.com & navigate to the myPharmacyCenter section.
2. Up to a 90-day supply of a covered maintenance drug
3. Co-pay, Participation or Deductible amount is based on your medication’s tier assignment. To check tier level, visit: www.UMR.com & navigate to myPharmacyCenter you may also call OptumRX at 877-559-2955.
Dental Claims – MetLife
Address: MetLife Dental Claims, PO Box 981282, El Paso, TX 79998-1282
Phone: 800-275-4638
1. To find a Network Provider go to: www.metlife.com/mybenefits
2. Claim forms can be obtained by calling 800-275-4638 or downloaded from www.metlife.com/dental
Vision Claims – MetLife
1. If you select an In-Network Provider, the Provider will file a claim.
2. To find a Network Provider go to: www.metlife.com/mybenefits
a. Provider Network: Metlife Vision PPO plan
Vision Claims – Out-of- Network Claims
Address: MetLife Vision Claims, PO Box 385018, Birmingham, AL 35238-5018
Phone: 855-638-3931
1. If you select an Out-of- Network Provider, you may provide full payment at time of service, and submit the invoice including an itemized statement of charges with your claim form.
2. Claim forms can be obtained by calling MetLife at 855-638-3631 or online at www.metlife.com/mybenefits
Flex Claims – Discovery (Unreimbursed Medical & Dependent Care)
Address: Discovery Benefits, PO Box 2926, Fargo, ND 58108-2926
Phone: 866-451-3399
Fax: 866-451-3245
1. Complete the Out-of-Pocket Reimbursement Request Form (available in Human Resources)
2. Submit one form per receipt or lump all receipts together & submit one form.
a. Dependent Care Reimbursement Information – have provider sign form and submit with proper documentation.
3. Documentation Requirements: date service was receive or purchase made, description of service or item purchased, dollar amount, & name of merchant/provider.
4. You may view account history or submit claims online at: www.discoverybenefits.com
Unacceptable forms of documentation:
1. Provider statements that only indicate the amount paid, balance forward or previous balance
2. Credit card receipts that only reflect a payment
3. Bills for prepaid dependent care/eligible expenses where services have not yet occurred