Get Nhis Claim Form

Completing the Nhis Claim Form online can streamline the process of submitting your claim for medical expenses following an accident. This guide provides straightforward and supportive instructions to help you navigate the form efficiently.

Follow the steps to successfully fill out your Nhis Claim Form

1. Click ‘Get Form’ button to access the claim form and begin filling it out online.
2. Part 1 of the form requires you to provide school information. Fill in the school system, school name, school address, student’s name, grade level, date of birth, time of injury, date of injury, and a description of the accident. If applicable, indicate the sport if the injury occurred during an athletic activity.
3. In Part 2, input the student's information, including their social security number and address. Next, provide the parent or guardian's information, including their name, employer, and employer's address for both mother and father.
4. List all insurance policies that apply to the student. Include the name of the insurer, their address, and phone number. If the student does not have insurance, check the appropriate box.
5. Complete the claim form within 90 days from the date of the injury. Attach itemized bills of medical expenses to your submission, ensuring they contain all necessary details like the provider's name, address, type of treatment, and diagnosis.
6. Submit the completed form and itemized bills back to the school. Ensure you include any necessary documentation, such as the Explanation of Benefits from other insurance providers.
7. Once you have submitted your claim, you may save any changes, download the form for your records, print it out, or share it with appropriate parties as needed.

Complete your Nhis Claim Form online today for efficient processing of your medical claims.