![]() ![]() Following are some insurance agents in the state of Georgia we pick for you based on your search preferences. You should talk to more insurance agents near Villa Rica, Georgia before choosing your Insurance Agent. PSI-Georgia Insurance does not have a web site in our record. A bachelor degree is not required to become a licensed broker, but they have to complete continuing education coursework to maintain license. Some brokers or agents specialize in one area of insurance like life, auto, death or health insurance. An insurance agent, also known as insurance broker, sells, solicits, or negotiates insurance for compensation. The Standard Industrial Classification(SIC) of PSI-Georgia Insurance is 641112-Insurance. We will appreciate if you let Thomas Dickerson know that you know the business and get the phone number from. Please call PSI-Georgia Insurance at (770)459-1859 for more information about their services. Thomas Dickerson is the owner or official contact person(Owner). Forms Personal Representative Appointment Form Specific Case Authorization Form Enrollment Form Medical Claim Form Claim Information Form Pharmacy Claim. There is no additional charge to you for the discount program.The office address of PSI-Georgia Insurance is 93 Hickory Gln Villa Rica, Georgia. This booklet describes the products and services available to you at discounted rates. This program provides discounts on a wide variety of health care services from a nationwide network of health care professionals and facilities. You also have rights regarding your health information that are described in this notice.Īnytime you travel more than 100 miles from your home or to another country and experience a medical emergency, you can make a single phone call to the Operations Center for help! You call will be answered by a medically-certified crisis managers who can put in motion a vast number of emergency resources to solve any problem, 24/7. This form explains how we may use information about you and when we can disclose that information to others. We are required by law and committed to protecting the privacy of your health information. This form describes how we will obtain your written authorization prior to use or disclosure of your health information. This form is used for reimbursement of prescription drugs. If you did not present your ID card when you purchased your prescription out of pocket, you will need to submit this form for a refund. Along with this form for prescriptions filled at a network pharmacy, please attach the paid prescription receipt and the paid cash receipt to: ![]() By providing the injury/sickness information we are able to process your claim accurately and efficiently. Please download this form if you’ve received a request from us for more information regarding a claim submitted by your doctor or if you would like to speed up the claim process. Mail claim to: UnitedHealthcare StudentResources P.Make sure all bills or itemized receipts indicate a diagnosis code, procedure code, date of service, cost, and the provider’s tax ID number.Clip, do not staple, all bills to the completed form.Please keep in mind when you are requesting reimbursement: This form can help you get reimbursed for all covered medical benefits which you have already paid out of pocket. It will show you the rates, coverage periods, and any optional coverages available to you. This is the form that you will use to sign up for the School Injury and Sickness plan. The Specific Case Authorization Form gives us permission to discuss only one specific medical condition with your Personal Representative, as you would specify on the form. If you would like a parent or another specific person to assist you with filing your claim and to be able to discuss details of your claim with our claim department, you will need to complete and sign this form. This form is filled out once and is good for every injury/sickness for the entire school year. The Yearly Authorization Form gives us permission to discuss any and all medical conditions with your Personal Representative throughout the school year. If you would like a parent or another specific person to assist you with filing your claim(s) and to be able to discuss details of your claim(s) with our claim department, you will need to complete and sign this form. Personal Representative Appointment Form (PRA)/Yearly Authorization Form ![]() Personal Representative Appointment Form.If you already have Adobe Reader and still have trouble opening these forms you might need to download the most recent version of Adobe Reader. To view or print the PDF files, you’ll need a free utility called Adobe Reader. ![]()
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