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)