How to Submit a Claim Form
When an injury is school-related, a School Administrator should complete and sign PART A of the claim form.
- select the "Claim Form" pdf below;
- complete PART A of the claim form. To avoid processing delays, answer all questions pertaining to the school-related injury;
- sign or type the school official's name in PART A of the claim form;
- when PART A is completed, save and print a copy of the claim form for your records;
- mail, fax or email the completed claim form to:
Student Assurance Services, Inc.
P.O. Box 196, Stillwater, MN 55082;
Claims Fax: (651) 439-0200
Email: claims@sas-mn.com
If faxing, include a cover sheet with your name and contact information.
If possible, email or send the completed PART A claim form to the student to complete the remaining part(s) of the claim form. The student should submit their completed form to Student Assurance Services.
Student Bills and Other Documentation
The student is responsible to make sure the following information is submitted to Student Assurance Services: itemized bills, showing the diagnosis and procedure codes, any medical insurance Explanations of Benefits, any other supporting documentation, such as letters, medical records, etc. This information can be emailed, faxed or mailed it to:
Student Assurance Services, Inc.
P.O. Box 196, Stillwater, MN 55082
Claims Fax: (651) 439-0200
Email: claims@sas-mn.com
Policies have timely filing deadlines, so please submit the claim form as soon as possible.