Welcome to the Student Benefits Health Provider Registration Form.
Copy the FIRST DIRECT DEPOSIT RECORD into ALL empty records - or just to this record.
Terms and Conditions
The PBAS Group, and their Administrators has taken the necessary measures to protect the confidentiality of the personal information provided and to ensure that your electronic transactions are secure.
Provider Authorization Confirmation I, hereby confirm that the information contained in this form is true and complete to the best of my knowledge or any of my colleague’s knowledge; and, that the student for whom I am making a claim is aware that a claim is being submitted to The PBAS Group their behalf. The student will be notified by email when payment has been released.
As a provider, The PBAS Group has the right to verify the accuracy of the information you have provided to support the claim. The PBAS Group may request the original receipts and any supporting documents within 12 months of the date your submitted the claim online. I understand and authorize that in the evidence of fraudulance claim, The PBAS Group has the right to release the claim to all relevant regulatory, investigative or government body, student organization or any other party as provided by the law of investigating such fraud.
Health Provider Registration