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Get EIIA Claim Form

Ble expenses must be submitted within one year from the date of service. All insurance you are covered by must be filed first before benefits will be considered. Please be sure you have provided your medical providers with a copy of your plan or ID card so they can bill directly! SEND COMPLETED FORM TO: NAHGA Claim Services PO Box 189 Bridgton, ME 04009-0189 For questions call: 877.497.4980 Fax: 207.647.4569 Email: eiia nahga.com SECTION 1: STUDENT STATEMENT MUST BE COMPLETED & SIGN.

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