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MEDICAL INSURANCE CLAIMS INSTRUCTIONS

HTH Worldwide has to know about a student's visit to the doctor in order to cover visit expenses and to reimburse for the prescription drugs. Therefore, there are two forms that a student has to fill out.

Member Claim Form

Usually a medical office will directly send the bill for a student's visit to HTH Worldwide. If that's the case, a student doesn't have to send this form to HTH Worldwide.
However, if a medical office does not report a student's visit to HTH Worldwide and sends the bill directly to a student, then HTH Worldwide does not know about the situation and will not take care of the bill. The Member Claim Form was developed to help students to notify HTH Worldwide about any health services that need to be covered.

Instructions:

  • PATIENT INFORMATION and INSURED INFORMATION (on ID card)
    This section is used to identify a student/patient. Some of the information for this section can be found on the HTH Worldwide ID card.
  • MEDICAL INFORMATION
    This section is used to report any health services that are COVERED by HTH Worldwide. List in order dates of visits, doctor's names, types of medical services, diagnosis, and amounts charged. Student's signature is required. A photocopy of a bill should be attached to the Member Claim Form.
    *Second page of the Member Claim Form demonstrates the filing procedure

Prescription Drug Claim Form

The student is responsible for the costs of the outpatient prescription drugs. HTH Worldwide refunds a student by sending a check after it received the Prescription Drug Claim Form and processed the claim.

Instructions:

  • INSURED'S INFORMATION
    This section is used to identify a student/patient. Please sign this part and write the TOTAL AMOUNT of money spent on prescription drugs.
     
  • PRESCRIPTION (Rx) INFORMATION
    A student must attach the original paid pharmacy receipt(s) and a prescription information such as drug quantity, drug name and strength (All this information is available on the printout that the pharmacy gives you during a check-out. Ask a person at a check-out which part of the print-out you should mail and they will show it to you)

Mail forms to:

HTH Worldwide Insurance Services
PO Box 968
Horsham, PA 19044

(it is listed on both forms)
For a list of doctors in 20 miles radius from the CIP office please click here. Students can perform their own search for practitioners and medical facilities after signing-in at www.hthstudents.com