There are two ways you can file a claim for benefit.
OPTION 1: PROVIDER SUBMISSION
The most common way to file a claim is to present your Select Benefits ID card to your provider. Ask your provider to accept an assignment of your benefits and to bill Select Benefit Administrators (SBA) directly. Note that the provider is under no obligation to do this. In that case, file the claim yourself as instructed below.
If your provider does bill SBA, the benefit will be paid to them and you’ll be sent an Explanation of Benefits a few weeks later showing what was paid. Your provider may send you a bill if there’s any remaining amount owed.
OPTION 2: EMPLOYEE SUBMISSION
If you paid your provider at the time of service, you may submit a claim to SBA using a Select Benefits Claims Form for Policy Benefits
. SBA then will pay benefits directly to you based on the amount covered by your Select Benefits Plan. For faster response, request a copy of the itemized bill from the provider. Ask for Health Care Financing Administration (HCFA) forms for doctor’s office visits and Universal Billing (UB92) forms for hospital care.
Attach to the form a copy of your itemized bill or the claim form given to you by your provider. An Explanation of Benefits from another insurance plan isn’t an acceptable receipt.
Verify that the following appears on the bill or claim form:
- Patient name
- Provider name, address and identification number
- Diagnosis or ICD-9 code(s) [description of your medical condition]
- Procedure or CPT or revenue codes [indicates the services rendered]
- Date(s) of service
Mail or fax the form to:
Select Benefit Administrators
Attention: Claims Department
P.O. Box 4250
Houston, TX 77210-4250
Fax: (715) 682-5919
LIFE INSURANCE CLAIMS
If an employee or a covered dependent of an employee dies while covered under the group policy’s life insurance benefit, please call a claims representative at Select Benefit Administrators at 1-800-497-3699.