Get Uhcsr Claim Form 2021-2025

Filing a claim can be a straightforward process if you follow the right steps. This guide will walk you through filling out the UHCSR Claim Form online, ensuring you have all the necessary information at hand.

Follow the steps to complete the UHCSR Claim Form effectively

1. Click ‘Get Form’ button to obtain the claim form and access it in your preferred editor.
2. Begin by filling in the insured student information section. Provide details such as the SR ID number, last name, first name, middle initial, home phone number, date of birth, mailing address, and email address.
3. Next, if the patient is different from the insured, fill in the patient information section with their SR ID number, last name, first name, middle initial, home phone number, date of birth, mailing address, email address, and their relationship to the student.
4. In the sickness/accident/injury information section, specify what the student or dependent was treated for. Indicate the date of the sickness or injury, type of accident (e.g., automobile accident, sports-related), and the location where it occurred.
5. You must describe how the sickness, accident, or injury occurred in the provided space, ensuring clarity and detail.
6. Provide the required authorization by signing the form. If the insured is under 18, a parent or guardian should sign and date the form.
7. Complete the other insurance information section if applicable, indicating whether the patient is covered by another insurance plan, along with the policyholder’s information.
8. Review the fraud warning statement included in the form to ensure you understand the legal implications of the information you are providing.
9. Once all fields are completed, make sure to save your changes. Then choose to download, print, or share the completed form as needed.

Complete your UHCSR Claim Form online today to ensure a smooth claims process.