SPRINGFIELD COLLEGE STUDENT & ATHLETICS INJURY INSURANCE PROGRAM
Welcome to the Springfield College Student & Athletics’ Injury Insurance Program claims administration webpage. A-G Administrators, Inc., through our partnership with Gallagher Student Health & Special Risk, is proud to serve Springfield College Students as the claims administrator for your program. Through the resources below you can: review the program’s Schedule of Benefits, learn what you need to do to file a claim, complete and submit a claim form electronically, securely upload claim documents, submit inquiries to determine the status of your claim, and obtain our contact information to submit claims documents through fax, email, or the mail.
3 DOCUMENTS ARE NEEDED IN ORDER TO FILE A CLAIM:
1. A Completed Claim Form. Please click the icon below to download the claim form, complete it, print it, and have your athletic trainer sign it. Once you have a signed claim form, please submit it to A-G Administrators, Inc. through our secure portal, email, fax or US mail to:
2. 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. We typically require a CMS-1500 (HICF) or UB04 form from the provider. Account statements or “balance due” statements are helpful but do not contain all of the information to process the charges.
3. The Explanation of Benefits (EOBs) from any other health insurance, if you have other health insurance. These documents can be uploaded through our secure portal, emailed, faxed or mailed to the address listed above.
Uploading your claims documents through our secure portal is safe and easy. Simply click on the hyperlink (first time users will be asked to create a profile and provide basic contact information), select your documents (or drag and drop) and click the “Upload Files” button. Within seconds you will receive a confirmation message on the screen informing you of a successful upload!
You may check on the status of your claim in one of 2 ways:
1. By calling our office directly on our toll-free line (800) 634-8628
2. By completing the form below and submitting it to us. A member of our customer service team will be in touch with you shortly.
Attn: Springfield Claims
P.O. Box 979
Valley Forge, PA 19482
(800) 634-8628 (Toll Free)
(610) 933-4122 Fax
Plan Management and Brokerage Services provided by: