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Insurance Claim

How to File a Claim with A-G Administrators

To process a claim with A-G Administrators, you must submit three main documents and follow the correct submission method.

 

1. Required Documents 

  • Completed and Signed Claim Form – Must be filled out in full, including the “other insurance” section.
  • School officials complete the school portion; parents complete the remainder.
  • The form opens a claim for the treatment of the injury.
  • Itemized Bills – Copies of all medical bills showing:
  • Provider’s name and address
  • Date of service
  • Type of service
  • Charges
  • Account statements or “balance due” statements are helpful but not sufficient alone.
  • Explanation of Benefits (EOB) – From the student’s primary health insurance carrier if applicable.
  • If the primary insurance does not pay in full, A-G Administrators will need the EOB before issuing benefits.
  • If there is no primary insurance, this is not required.

2. Key Tips to Avoid Delays 

  • Complete the “other insurance” section of the claim form fully.
  • Provide all itemized bills; do not rely solely on account statements.
  • If the student has other medical insurance, submit bills to the primary carrier first and obtain their EOB.
  • Keep copies of all submitted documents.
  • If possible, have the provider file directly to A-G Administrators as secondary accident insurance to save time.

Claim form (English) (Spanish)

 

Once the claim form is completed and signed by a school official, the signed form and the supporting documentation can be submitted using the following links: