Follow the steps to successfully complete the claim form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the policy number in the designated field at the top of the form.
3. Fill in the group name, which in this case is Hofstra University.
4. Provide your member ID number in the specified area.
5. In the section labeled 'Name of Insured,' enter the full name of the insured individual.
6. Record the date of birth of the insured individual in the format MM/DD/YYYY and select the corresponding sex.
7. In 'Name of Claimant,' write the name of the person filing the claim, followed by their date of birth and sex.
8. Complete the current residence address of the claimant accurately.
9. If the claim pertains to an accident, describe the details, including how, when, and where it occurred.
10. If it's related to an illness, document when and where symptoms first appeared, along with the nature of the illness.
11. Indicate whether treatment was sought at the Student Health Center by checking Yes or No. If Yes, be prepared to provide documentation of treatment dates.
12. List the names and addresses of any consulting physicians, nurse practitioners, or physician assistants involved.
13. Answer whether you have previously been treated for the same illness by checking Yes or No, and provide the date if applicable.
14. Record the name and address of your primary care physician or regular physician.
15. List any prescription medications you are currently taking.
16. Indicate if there is any other health insurance coverage, providing details as requested.
17. Authorize the release of information by signing in the designated space, stating the date.
18. Lastly, ensure all fields are complete, save your changes, and then download, print, or share the completed form as needed.

Complete your CBP Gerber Life Medical Claim Form.doc online today for a smooth claims process.