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Claim Form

Click here to download a claim form or for online

You can download or submit a claim online. However, all claims involving a school related injury will need to have Part A completed by a school official.

Texas Schools Only
For Texas schools participating in the USA MCO provider discount program. Please have your school complete part A of the claim form. The claim form can be found under "Find My School". The claim form must be presented to your provider in order to obtain the discount. Please contact your school for any questions.

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