Claim Procedure

In the event of an Injury or Sickness, the insured person should:

1. Report immediately to the Student Health Center to obtain a claim form.
2. Notify the claims administrator within 30 days after the date of the injury or commencement of the sickness, or as soon thereafter as reasonable possible.
3. Complete the claim form in full and sign it. You may download an online copy of the claim form here. (PDF Format)
4. The completed claim form should be mailed within 90 days from the date of injury, or from the date of the first medical treatment for a sickness, or as soon as reasonably possible. Retain a copy for your records and mail to the Claims Administrator at the address below.
5. Itemized medical bill must be attached to the claim form at the time of submission. Subsequent medical bills should be mailed promptly to the Claims Administrator. No additional claim forms are needed as long as the insured person’s name and identification number are included on the bill.

Direct all questions regarding benefits available under this plan, claims procedures, status of submitted claim, or payment of a claim to the Claims Administrator, Administrative Concepts, Inc. at the address below. The office hours are 8:30 AM to 5:00 PM Monday through Friday.

REMEMBER THAT EACH COVERED INJURY OR SICKNESS IS A SEPARATE CONDITION AND REQUIRES A SEPARATE CLAIM FORM.