Ilstu Health Insurance Form
For prescription costs please review the current benefit choice options booklet group insurance forms.
Ilstu health insurance form. 2020 professional practice student health insurance certification form use for fall 19 spring 20 and summer 20. The department of central management services cms administers group health vision dental and life insurance benefits for four benefit programs. Dependent coverage is also available. Physical examination form professional practice health insurance certification f20 sp21 su21 acknowledgement of risk statement.
Ub92 or ub04 billing from a hospital. A completed aetna claim form. Health benefits for workers with disabilities hbwd is illinois medicaid buy in program authorized under the federal ticket to work work incentives improvement act twwiia. Please contact a benefits counselor at 309 438 8311 for more information on benefit services.
Student health insurance the student health insurance office has reopened. An itemized bill from the provider of the service. Monday friday 8 00am 4 30pm. Student health insurance certification forms.
At this time idph recommends against testing persons with mild illness who can be safely managed at home unless a diagnosis may impact patient management. Students at illinois state have two options for getting insurance. The health plans map specifies which plans are available in your area. Accepted forms are hcfa 1500 billing from a physician.
For the health and safety of students and staff student health insurance requests customers to please call 309 438 2515 and to mail student insurance campus box 2541 normal il 61790 or fax medical claims if possible. Mcninfo ilstu edu mennonite college of nursing campus box 5810 normal il 61790 5810 phone. The online form requires adobe acrobat reader or you may pick up a form at the student health insurance office. 309 438 7400 contact us.
Prescription benefits are included with each of the health plans. These forms are downloadable and available in adobe portable document format pdf. Consult the current benefit choice options booklet to learn more. If other insurance exists attach payment denial school illinois state university policy number 711123 student name.
Apply for medical assistance. Student health services shs is working diligently to follow guidelines from the illinois department of public health idph. The university s student health insurance provides excellent coverage at a reasonable cost. Illinois comprehensive health insurance plan chip a state health insurance program for illinois residents that are considered high risk.