Professional Documents
Culture Documents
Date: 01/12/2017
ANDRES CEDENO
299 Diamond Village Apt# 10
Gainesville FL 32603
NOTE: If your policy has an Excess Coverage provision and you have other
medical insurance please mail all bills to that insurance company
immediately. When you receive the Explanation of Benefits (EOB) form(s) and/
or their claim denial letter(s) please forward us a copy of those documents.
You can provide the requested information using any of the following methods:
Login to www.uhcsr.com/OthIns
Email to customerservice@uhcsr.com
Fax to (469) 229-5625
Call Customer Service at the number on your ID card or (800) 767-0700
between the hours of 7:00 AM and 7:00 PM, Central Standard Time,
Monday through Friday
Mail to the address listed above
Please note, FAX or MAIL are the only secure methods of returning Protected
Health Information to UnitedHealthcare StudentResources. You may also email
your information; however, transmission via email is not a secured method. If
you elect to return information to UnitedHealthcare StudentResources via
email, you have voluntarily made the decision to utilize an unsecured
transmission.
If you have other insurance coverage, please provide the following for each
member of your family covered under your student Insurance Policy:
Policyholder's Name:
____________________________________________________
Policyholder's Address: __________________________________________
If you do not have any other coverage for yourself or any member of your
family under another insurance policy, please sign the following statement
and return this letter to us.
"I hereby certify that neither I, nor my spouse, nor any other
family members have any other type of medical insurance."
Sincerely,
Claims Department
26
LETTER NO: 26
LETTER DCN: 170129300764
SRID: 5059928
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