For an incident of accident or illness that begins in the school year 2004-2005, choose one of the following claim forms for the school or university you attend.

Please ensure that you have downloaded the correct form for your school or university. Fill out the form completely and follow the instructions for submittal at the top of the form. To help expedite claims adjudication, complete a claim form for every new accident or illness.

Incomplete claim forms will result in a processing delay. A claim form is considered complete if all questions have been answered and the form has been signed by either the insured student or a parent or guardian if the insured is a minor.