Claims Assistance
Insurance Claim Process
After you receive services or treatment, your provider will submit a claim to the insurance company for payment. HealthSmart Benefit Solutions processes claims for the Student Health Benefits Plan. HealthSmart will process the claim and issue payment to the provider.
Both you and your provider will receive an Explanation of Benefits (EOB). The EOB is a statement saying who pays for what and how much. An EOB is not a bill, and you should not send a payment to HealthSmart. If you owe for services, your provider’s office will send you a bill. Always check your EOB to make sure the amount you owe for services is the same on both the provider’s bill and the EOB. Sometimes, providers will send a bill before receiving all the payment from HealthSmart.
You may view your benefits and claims through the HealthSmart myHealth portal.
Coordination of Benefits
To ensure your claims are paid correctly, HealthSmart may ask you for information regarding any other insurance you may have. When a member is covered by more than one insurance policy, the insurance companies must coordinate payment of benefits to ensure providers are paid correctly.
If HealthSmart needs additional information regarding other insurance coverage you may have, they will request it via your Explanation of Benefits (EOB). Please review all EOBs received by HealthSmart.
If additional information is needed, you can call HealthSmart directly at 844-206-0374 or complete the form below. Even if you do not have other insurance coverage, you must complete the form or call HealthSmart so they can update their records and continue processing your claims.
- HealthSmart Insurance Response Form (For domestic students only)
Accident Details
If your provider submits a claim with a diagnosis code that could potentially be the result of an accident, HealthSmart may ask for Accident Details to ensure your claim is paid correctly. Common injuries that could be the result of an accident are sprains, fractures, wounds requiring stitches, burns, animal bites, motor vehicle, bicycle, or scooter accidents, falls, and work-related injuries.
If HealthSmart needs additional information regarding potential accident claims, they will request it via your Explanation of Benefits (EOB). Please review all EOBs received by HealthSmart.
When you see “Accident Details needed” on your EOB, please call HealthSmart directly at 844-206-0374 or complete the form below. If you do not respond to this request from HealthSmart, your claims may not get paid, and your provider may expect that you are responsible for the entire amount.
Reimbursement for Services
If you have paid for medical or dental services yourself, you may be eligible for reimbursement under the Student Health Benefits Plan. Use the forms below to submit a claim for consideration to HealthSmart (medical, prescription drug) or Delta Dental (dental) for reimbursement.