In order to file a claim you must first have a claim form. If you already have a claim form please scroll down to the claim filing procedures below.
Note: This form and instructions are for students grades K-12 and/or students with the Student Accident & Sickness Plan. For other forms please call 949.348.0656
Procedures
- Report school related injuries to the school within 72 hours.
- Have school complete Part A of the claim form. Parents may fill out Part A if injury is not school related.
- Parent or Guardian fill out Part B.
- IMPORTANT: Both parts must be completed in full or claim will not be processed.
- Mail, fax, or scan & email the form to our office with all itemized bills within 90 days of the first date of treatment.
- At the same time, please file a claim with your other family health and/or accident carrier. This can include employee plans, union plans, CHAMPUS (military plans), service contracts, self-insured benefit plan, or health maintenance organizations (HMOs).
- When you receive notice of payment, a notice of denial, or a letter stating you have met your deductible from your health and/or accident carrier, please forward this information to our office.
- If you have any questions, please call our office at 949.348.0656 and ask for the claims department.