Get Claim Form - Ascension Benefit & Insurance Solutions-- Student ...

Filling out the Claim Form is a crucial step in obtaining benefits from ASCENSION Benefit & Insurance Solutions. This guide provides clear instructions to help you complete your claim accurately and efficiently online.

Follow the steps to complete your claim form online.

1. Click ‘Get Form’ button to access the claim form and open it for editing.
2. Begin by entering the name of your school in the designated field. This is vital for identifying your coverage.
3. Provide the insured's Social Security number and contact information, including phone number and present address. If there is a home address that is different, include that as well.
4. If the claim is for a dependent, include their name and relationship to the insured. This information is necessary for processing dependent coverage.
5. Indicate whether you are covered by any other hospital and/or medical plan. If yes, specify if you are insured or a dependent, and provide the name and policy number of the respective insurance company.
6. Detail the nature of the sickness or injury, including the date of the incident, and provide specifics on how and when it occurred. Indicate if it was work-related if applicable.
7. If the injury was related to a sport, check the appropriate box to identify the sport. Ensure accuracy to avoid delays in processing.
8. Mention if you have previously experienced similar conditions and provide the names of other physicians you consulted.
9. If hospitalized, provide the name of the hospital and the dates of your stay. Also indicate if a health center referral was made.
10. Complete the payment information section by ensuring that all itemized bills for medical expenses are attached, as these will be required at the time of submission.
11. If applicable, ensure that the form is signed by the college official, accompanied by their title and the date. This is particularly important for intercollegiate sports claims.
12. Finally, review the entire form for accuracy. Once completed, you can save changes, download, print, or share the form as necessary for your submission.

Submit your claim form online today to ensure prompt handling of your benefits.