Questions & Answers From A-G Administrators

Accident insurance, sometimes referred to as participant accident insurance, is coverage that helps pay medical treatment expenses when someone is injured in an accident. It is usually used to pay for the deductibles, copayments, and other out-of-pocket expenses primary health insurance does not cover. Or, in instances where someone does not have primary health insurance, its benefits can be used toward medical bills.

With rising healthcare and health insurance costs, accident insurance is an affordable way to help protect a family’s budget from financial risk if a child is accidentally injured.

All claims require an Accident Claim Form, Itemized Bill, and the corresponding Explanation of Benefits (EOB) from the patient’s primary medical insurance (if the accident policy is secondary) to process payment. Submitting incomplete insurance claim forms and files may cause a delay in processing. You will be contacted by the Claim Examiner if the information is missing.

Also, please make sure all attachments are clear and legible as illegible documentation may cause a delay in processing. PDF attachments are the easiest for our Document Center to view and upload into our system.

This is the form that starts the claim process when a child is injured. When submitted, a completed Accident Claim Form is used to open a new claim in our system. We cannot process insurance claim payments without one. It verifies the date of injury, the body part that was injured, and how the injury occurred. It also includes required signatures from the athlete/participant (or guardian) and the school or organization official. Please view our Document Library for electronic copies of the Accident Claim Form.

An itemized bill is a detailed billing form that includes the date of service, billed amounts, CPT Codes (Current Procedural Terminology), Diagnosis Codes, Provider Tax ID Number and Address, along with patient information. This information is required because we cannot process payments from statements that are not itemized. Itemized bills can be accessed from your provider. A CMS 1500 form is a common form from a physician, and the UB 04 form is a common form from a hospital or facility. These forms will have all of the necessary information A-G Administrators requires to satisfy each charge’s itemized bill requirement.

Because our policies are excess accident, all charges must first be submitted through the patient’s primary insurance. To verify that each charge has been submitted through your primary insurance, and show how they have processed the charge, we also require an Explanation of Benefits (EOB). The EOB breaks down each charge by date of service and CPT Code and includes the total billed amounts, discounts, adjustments, and payments made.

The easiest way to access your EOB’s is through your primary insurance’s online portal. Almost all major insurance companies have electronic EOB’s accessible to participants online for prior treatments. You may also receive hard copies of the EOB’s in the mail, or can receive copies through your provider.

If you or your child does not have primary medical insurance, or have a Medicaid/Medicare Plan, A-G Administrators may act as the primary insurance. Please submit documentation stating you do not have any other insurance or your Medicaid/Medicare Insurance Card for review.

A-G Administrators provides a variety of methods for submitting claim documents. Please refer to the Claim Submission page for full details.

A-G Administrators does not pre-authorize or guarantee benefits, and all claims are reviewed upon receipt. Benefits are paid at Usual, Customary, and Reasonable (UCR) rates.

Please contact customerservice@agadm.com or (610) 933-0800 and have the patient name, patient date of birth, date of injury, and school or organization they belong to ready. Benefits and eligibility are based on the school or organization they belong to, and the injury that occurred.

If you have already made payments, you may be reimbursed for covered charges. We will still need the itemized bill and corresponding EOB for each charge, in addition to your proof of payment (receipt, copy of check, etc.). If proof of payment is not submitted prior to processing, payment will be issued directly to the provider, and you will need to contact the provider for reimbursement.

The timely filing deadline for each policy may vary, however we recommend submitting claims within 90 days from the date of service. A-G Administrators will always review a claim submission, so please submit the complete claim documentation for final determination.

Once the completed Accident Claim Form, Itemized Bills and Corresponding EOB’s are submitted and legible, the processing time of a claim is approximately 5-10 business days. If additional information needs to be requested, this will delay the process.

To check the status of a claim, complete the short form on the Check Claim Status page or call A-G Administrators directly at (610) 933-0800 (M-F 8:30am-6pm EST). We will return your call or respond to your form submission as soon as we are able.

Accident insurance covers the excess medical treatment costs of accidental injuries (the deductibles, copayments, and out-of-pocket costs after the primary insurance has paid). We offer several different types of plans at A-G. Examples include:
Student accident plans that cover children from accidents that happen during the school day. From playground injuries to slips and falls in the cafeteria to cuts from broken glass in chem lab—if a child is injured in an accident, that’s what we’re here for.
Student-athlete accident plans that cover children from accidents that happen during sports. Whether it’s at practice or at a game, when sports injuries happen, A-G is there.
We provide mandatory, voluntary, compulsory, and catastrophic plans for K-12 schools, colleges and universities, events and camps, and offer other special risk accident insurance solutions.

Accident insurance is an affordable way to protect against the financial risks of accidents and their treatment. However, each school and program’s needs are unique, and we work closely with them to develop their best solution. Because of this, we’ve found it’s more accurate to talk to one of our insurance specialists to get an idea of how much it may cost you. But we think you’ll be surprised at what you learn.

No, accident insurance only covers injuries caused by accidents. It doesn’t cover any illnesses.

No, we only offer the policies to a school or program as a group. Coverage is not available on an individual basis.

No. We only offer accident insurance coverage to help cover medical expenses.

Al Gillis, our founder, started A-G Administrators in 1983, and his sons Dixon and Jake grew up in the business. We have been providing accident insurance to thousands of K-12 schools, colleges and universities, events, camps, tournaments, and other organizations for nearly 40 years. Protecting families, students, student-athletes, schools, and programs from financial risk is at the heart of everything we do. You can relax knowing that’s the commitment you get from us. (Plus, we have industry-leading technology in our proprietary claims management system, EGBAR, that practically eliminates paperwork and red tape.)

Our carriers are rated A+ (Superior) by AM Best for their ability to meet ongoing obligations and their financial strength. You can read more about the rating here.

Please don’t hesitate to call us directly at (610) 933-0800 (M-F 8:30 a.m. – 6 p.m. EST) or complete this form. We will return your call or respond to your form submission as soon as we are able.