Visit the campus health center first before receiving any treatment off campus. If you receive a referral to be seen by an outside provider, keep the signed Referral Form until you are ready to submit your claim.

Location: 2147 E Street, La Verne, California 91750

Phone: (909) 448-4619

Hours: Monday – Friday: 8:00 a.m. – 4:00 p.m.

Closed weekends and school holidays. Consult the campus health center website for summer hours.

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 website (link below).

1. From the “Locate a Provider” screen, select “Start Now.”
2. Select the type of provider, such as physician or Urgent Care.
3. Select Search by ZIP code and enter your ZIP code.
4. Select the distance you are willing to travel to the provider (minimum of 5 miles).
5. Click “Search Now.”
6. 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.

The Pharmacy Benefits Manager for this plan is Wellfleet Rx/ESI. Please see the Wellfleet/Express Scripts website (link below) to find a pharmacy near you, or call Member Pharmacy Help at (877) 640-7940.

In the event of either an Injury or a Sickness:

1. Report to a Physician, Hospital or the School’s Student Health Services.
2. Written notice of a claim must be submitted to the address below within thirty (30) days after the date of Injury or commencement
   of Sickness covered by the Policy, or as soon thereafter as is reasonably possible.
3. Send all medical and hospital bills, along with the patient’s name and insured student’s name, address, Social Security number or student ID number and name of the University under which the student is insured, to the address below. A Company claim form is not required for filing a claim.

Wellfleet Group, LLC
PO Box 15369
Springfield, Massachusetts 01115-5369
(877) 657-5030, TTY 711
www.wellfleetstudent.com

Bills should be received by the Company within ninety (90) days of service. Keep copies of all the documents you submit. To
check the status of a claim you submitted, call (877) 657-5030, TTY 711 or visit www.wellfleetstudent.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 Member’s Authorization to Release Information form and send it to the address listed. This form is available below.

Students covered under the student insurance plan are automatically enrolled in Wellfleet Travel Guard. Travel Guard 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 Summary or visit the Travel Guard website (link below).