Use providers in the PPO network whenever possible.
It is best to locate an in-network doctor, urgent care center, and emergency room near you before you get sick. To find a PPO provider, call (800) 226-5116 or visit the First Health Network website (link below).
- From the “Locate a Provider” screen, select “Start Now.”
- Select the type of provider, such as physician or Urgent Care.
- Select Search by ZIP code and enter your ZIP code.
- Select the distance you are willing to travel to the provider (minimum of 5 miles).
- Click “Search Now.”
- Select a doctor from the list, and call to make an appointment.
Always check with the doctor or medical facility directly to confirm that they accept First Health before you receive treatment.
Pharmacy benefits are managed by Express Scripts. Express Scripts pharmacies include CVS, Walgreens, and Walmart. Please see the Express Scripts website (link below) to find a pharmacy near you, or call (800) 400-0136; Pharmacy Help Desk (800) 922-1557.
To fill a prescription, visit any Express Scripts pharmacy and pay the copay. If you visit a out-of-network provider, you must pay in full, then submit a claim for reimbursement.
If your provider files the claim on your behalf:
- The claims administrator still requires certain information from you. You will need to fill out a form indicating whether or not you have other insurance coverage. You will need to do this only once per academic year. You can find the Other Insurance Coverage Form below.
- You will receive an Explanation of Benefits (EOB) that outlines what the insurance company paid and what is your responsibility to pay, if applicable. The claims administrator will contact you if they need other information; otherwise, they will pay the claim as indicated on the EOB. Do not ignore calls or letters from the claims administrator, as this may delay payment of your claim.
If the provider does not file a claim directly with the insurance company on your behalf, you will need to submit a claim for reimbursement for the portion of the charges the company is responsible for paying by completing these steps:
- Download a claim form below and fill it out completely.
- Include your policy number (as shown on your ID card) on the claim form.
- Attach bills for X-rays, lab charges, etc.
- Send your claim form and all bills pertaining to this claim to Administrative Concepts, Inc. at the address below. Try to have all itemized bills attached to the same claim form.
Administrative Concepts, Inc.
994 Old Eagle School Road, Suite 1005
Wayne, Pennsylvania 19087
Fax: (610) 293-9299
Keep copies of all the documents you submit for claims. If you have questions about claims, contact Administrative Concepts, Inc. at (800) 476-4802 or email@example.com.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.
Students covered under the student insurance plan are automatically enrolled in the Scholastic Emergency Services (SES) coverage. SES offers many services to help students when traveling away from your school or outside the U.S., including medical emergencies during travel, help with lost luggage, documents, or medications, insightful pre-trip information, and more.
For additional information, see your plan brochure or visit the SES website.