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How to Submit a Claim Form

If you have incurred medical expenses, you may be required to complete and submit a claim form to Student Assurance Services, Inc. (SAS) to allow us to continue the processing of your claims. All claims related to an injury require the completion of a claim form. Only one claim form is needed for each injury or sickness. Intercollegiate sport accident claims must be signed and completed by an authorized athletic official - contact your athletic department.

You may complete a claim form from this website. The claim form is located under your school's plan 1) Click on "Find My School" 2) Select the state where the school is located 3) Search and select the school name 4) Click on "Claim Form".

Please complete the form fully and provide the requested information as accurately as possible. When you are satisfied that the claim form is ready to be submitted to SAS, you may:

1. Print a copy of the completed claim form. The printed
    claim form must be mailed, with any necessary
    supporting information, to Student Assurance
    Services, Inc. P.O. Box 196, Stillwater, MN 55082.
    Please keep a copy of the claim form for your records; OR

2. Click on "Submit Form" in the upper right hand corner
    of the claim form to electronically send the claim form
    to SAS. If you have any additional or supporting
    information, send it to SAS by fax 1-651-439-0200 or
    mail it to Student Assurance Services, Inc.
    P.O. Box 196, Stillwater, MN 55082.

Please do not fax or mail any claim forms or requests for information to Columbian Life Insurance Company, Columbian Mutual Life Insurance Company or Nationwide Insurance Company Doing so will needlessly delay the processing of your claim.

How to Submit a Claim Form for Prescription Drugs

If your student plan requires you to pay for prescription drugs at the pharmacy, you will need to submit a copy of the drug label with a claim form. Complete the claim form on the website by following the instructions above. If you complete an online claim form, you must fax, scan or mail the prescription drug label to SAS.

Note: If your student plan has a prescription drug program with Express Scripts or another pharmacy benefit company, you would have received a separate prescription drug ID card. There is no claim form to file if you use a network pharmacy. If you obtained your prescription drug from an out-of-network pharmacy, you must contact Express Scripts or the pharmacy benefit company listed on your prescription drug ID card for reimbursement.

To Providers only:
Student Assurance Services, Inc. can accept claims electronically through www.freeclaims.com under Payor ID FCSAS.
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