Insurance Forms & Resources
Insurance Step-by-Step Instructions
Any Sports Club participant who is injured during an approved Sports Club event (e.g., practice, competition, or team activity) must fill out an Injury/Accident Report Form and submit it to the Office of Student Life & Leadership (TSU 234) within 1 business day of the occurrence. If you have questions, please contact the Sports Club Coordinator at (657) 278-7622 or (657) 278-2093.
Any Sports Club participant who suffers a concussion specifically during an approved Sports Club event (e.g., practice, competition, or team activity) must also fill out a Return to Play/Learn Form and submit it to the Office of Student Life & Leaderhsip (TSU 234). The form must be filled out by a physician and the student cannot return to play until the form is turned in to the Sports Club Coordinator and information is verified that the student can safely return to play.
Filing an Insurance Claim
Sports Club students who need to file a claim using the Sports Club Insurance should follow the instructions below.
- Complete an A-G Administrators Athletic Accident Claim Form
- Deliver the form to the Office of Student Life & Leadership to the Coordinator of Sports Clubs (TSU 234) to get a signature.
If you have primary insurance, file a claim with your personal insurance carrier. Have the insurance carrier complete an “Explanation of Benefits” to be submitted with your claim. The student is personally responsible to mail in the HSR Form and all medical bills to HSR.
Send all forms (signed Athletic Accident Claim form & Explanation of Benefits, if applicable) and all itemized bills to:
A -G Administrators, Inc.
Claims Department P.O. Box 979
Valley Forge, PA 19482
Phone (610) 933-4122
Phone (800) 634-8628 (Toll Free)
Fax (610) 933-0800
The A-G Administrators Athletic Accident Claim Form enables us to open a claim for the treatment of your injury. To avoid delays in claim processing please be sure the “other insurance” portion of the claim form is completed in full. A school official such as a coach or athletic trainer must sign the claim form.
Itemized Bills: Please include copies of all medical bills, showing the name and address of the provider of service, date of service, type of service and the charges. Account statements or “balance due” statements are helpful, but do not contain all the information needed to process the charges.
Explanation of Benefits: If you have other medical insurance, all medical bills must be first submitted to that carrier for their determination of eligibility. If the charges are not paid in full by the other medical insurance carrier we will need to see a copy of the “Explanation of Benefits” from that carrier prior to issuing benefits from this office. If you have no primary medical insurance the need for an “Explanation of Benefits” will not be applicable to your claim.