Claim Form - Select "Complete a Claim Form" link below

  • To avoid processing delays, please submit a fully completed claim form. Answer all questions that pertain to your condition.

  • For intercollegiate sports injuries, please have your athletic department complete a separate sports injury claim form available from the athletic department.

  • If Health Center referral is required, the Health Center question must be completed.

  • Additional or supporting information, for example drug labels, itemized medical bills, primary carrier explanation of benefits, can be faxed, scanned, or mailed to Student Assurance Services, Inc. (SAS) for processing.

  • Upon completion of the claim form, you can either:
    1. Mail your claim form to SAS – select print; OR
    2. Electronically submit your claim form to SAS - select “Submit Form” on the upper right corner of the     claim form and follow the instructions.

  • Retain a copy of the claim form and any additional supporting information for your records.

    Complete a Claim Form (Windows)

    Complete a Claim Form (Mac)