Request for Information on Additional Health Insurance

 

Thank you for selecting the health insurance offered through your university. HealthSmart Benefit Solutions partners with the university to process claims submitted under this plan. (“Claims” are formal requests for the plan to pay for services you’ve utilized, usually submitted by the providers you see). We strive to provide a smooth and efficient process in the event you do submit a health insurance claim.

In order to avoid any delays in processing your future claims, it would be very helpful for us to know if we need to work with any additional health insurance plans that you and/or your dependent(s) may have. Please complete this secure form so that we can have this information on file.

Should you have any questions regarding the above, please contact us Monday – Friday from 8:00am – 5:00pm Eastern at the toll-free on your medical ID card, or email akronclaims@healthsmart.com. Thank you for your help in providing this information and we wish you the best of luck with your studies throughout the school year.

4. Are you covered by other health insurance? *
5. Who is covered by your other health insurance?
10. Do you have dependents (for example, spouse or children) who are covered by a different health insurance company not already listed in items 5-8? *
Secured by Formsite