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How to Submit a Claim Form

Choose the Claim Instructions below that match your policy type.

If you have incurred medical expenses, you are required to complete and submit a Student Assurance Services, Inc. company claim form. Only one claim form is needed for each accident.

Option to Mail, Fax or Email:
1. Select and complete the claim form located under your
    school's webpage. To locate your school, select "Find My
2. Select the state where the school is located.
3. Search and select the school's name.
4. From your school's webpage, select "Claim Form".
       a. Answer all questions for PART B and C on the claim
           form. When the claim form is completed, download
           and print a copy.
           Note - If the injury occurred at school, PART A
           must be completed by an authorized school

       b. Sign the claim form. The school official must also sign
           PART A if the injury occurred at school.
       c. Keep a copy of the form for your records.
       d. Mail, fax or email the claim form with copies of
           itemized bills and other supporting information
           (such as other insurance EOBs, letters, reports) to:
           Student Assurance Services, Inc.
           P.O. Box 196, Stillwater, MN 55082;
           Fax number: (651) 439-0200

Tips for Submitting Claims

If the accident occurred at school or during a school
   sport/activity, the claim form must be signed and
   PART A completed by an authorized school official -
   contact your school in this situation.

• If you fax claim information, always include a cover sheet
   with your name and phone number.
• To avoid processing delays, please submit a fully
   completed claim form. Answer all questions pertaining to    your injury.
• Balance due statements or receipts cannot be processed.
• Submit copies of itemized bills to your other medical or
   dental insurance plan first. This plan pays second or after
   other insurance coverage. Submit copies of your other
   insurance explanation of benefit (EOB) forms along with
   itemized bills to us for processing.
   (does not apply to SAS primary plans)
• Submitting the claim form and related bills is your
   responsibility. Do not rely on the school or health care
   provider to send claim information.
• Policies have timely filing deadlines, generally one (1) year
   and ninety (90) days from the date of service to submit
   proof of loss (may vary based on state law requirements).

If you have incurred medical expenses resulting from an accident or sickness, Consolidated Health Plans (CHP) is responsible for processing your claims. CHP has dedicated claims staff who can address your claim status or claim payment questions.

A claim form is not required, however you can obtain a CHP claim form from the CHP Home webpage at www.studentinsurance.com. You can also locate your CHP school page from our website, select "Find My School" then select "Plan Information". You will be directed to the CHP website. For claim questions, please call CHP customer service at (877) 657-5030.

Mailing Address:
Student Assurance Services, Inc.
P.O. Box 196
Stillwater, MN 55082

Customer Service:
Toll Free (800) 328-2739
Fax (651) 439-0200

Email to submit a claim:

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