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Explanation of Benefits

If you submitted a claim to HTH, you will receive an Explanation of Benefits form. This form includes your name, address, claim number and insurance number. You will then see the following:

Treatment Dates

Lists the date(s) you received the medical care that you are being billed for.

Charge Amount(s)

Will list how much you were charged for the service(s) by your doctor.


Shows how much of the amount charged you will have to pay for.

Note: If you went to the University Health Center first, or you went for emergency treatment, this section should always say $0.00.


Not Covered

Lists any charge that the insurance company will not pay for.

Reason Code

The service code is the company’s way of saying why a charge was not covered.

Note: If the reason is that the charge exceeds the Reasonable and Customary fee, that means that the doctor charged more than what the insurance company will pay for that service. If you talk to the doctor, they may not make you pay that amount, but they might.


PPO Discount

Is a reduced rate that the insurance company pays to a doctor if the doctor agrees to a discounted rate.

Eligible Charges

Is how much the insurance company will pay after the discount (if any) is subtracted from the original charge.

Deductible Amount

Is the same as the Co-Pay/Deductible.

Payment Amount

Is how much the insurance company paid on the claim.

The service code, which is used if something is not covered by the insurance. The explanation of those codes along with any messages from the insurance company are at the bottom of the form.

If you have any specific questions about your Explanation of Benefits form, please contact the insurance company at HTH Worldwide Insurance Services toll free at 1-888-350-2002.

You can also contact the International Insurance Office at (518) 591-8185 or stop by the office at SL G-40.

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Contact Information

International Student & Scholar Services

Science Library G-40
University at Albany
1400 Washington Avenue
Albany, NY 12222 U.S.A.

Office Hours:

9:00 AM to 5:00 PM EST
Advisement 9:00 AM to 4:30 PM
Monday through Friday


Phone 518-591-8189
Fax: 518-591-8171

International Student Advising Hours:

Main Campus:

Monday-Friday from 9:00am-5:00pm in Science Library G40

Downtown Campus (Alumni Quad):

Waterbury Hall Transfer/International Student Lounge

Every Other Wednesday:
OCTOBER 14, 28—10/28 signing Event for Travel
NOVEMBER 11 (no advising on November 25)
DECEMBER 9— Signing Event for Travel

East Campus (School of Public Health):

Student Affairs Room 120

Every Other Tuesday
DECEMBER 1—I-20 Signing Event for Travel

International Insurance Office

9:00 AM to 4:30 PM EST
Monday through Friday


Phone: (518) 591-8185
Fax: (518) 591-8171