Helpful Resources & Forms
This page contains a variety of helpful resources and commonly used forms. If you
need additional assistance or have questions about the appropriate use of these
forms, please call Customer Service at 1-800-767-0700, or
send us an email.
In order to share your health information with your Providers we need your permission. Simply print off the
FO - SI - 09 Authorization Form and fax or mail it to the address given on the form once you’ve filled it in.
To authorize another individual to act on your behalf for health insurance matters with UnitedHealthcare StudentResources,
simply login to My Account and complete the Personal Representative Appointment in the Forms and
Letters section of the home screen. Alternatively, you may complete the
Personal Representative Appointment Form and fax it to the number indicated on the form.
If you’ve received requests for more information regarding a claim, complete the
Claim Information Form and mail it to:
P.O. Box 809025
Dallas, TX 75380-9025
To request reimbursement for a pharmacy (OptumRx) claim, complete the Prescription Reimbursement Request Form and mail it along with your original pharmacy receipt(s).
These files are in PDF format. To read and print a PDF file you must have Adobe
Acrobat Reader Software 4.0 installed on your computer. Download the Adobe Acrobat Reader