1. Check your identification card for the name of your insurance company.
2. Click on the name of your insurance company to print the claim form.
3. Complete and sign the claim form. Be sure to answer all questions.
4. Attach itemized bills from the medical providers to the form and mail to:
   Administrative Concepts, Inc.
   994 Old Eagle School Road
   Suite 1005
   Wayne, PA 19087-1802
   You will receive a response in two weeks.

The following is a list of claim forms that are available online.
You will need Adobe Reader to view and print these forms.

• ACE Insurance Company
• AIG Insurance Company
• BCS Insurance Company
• California State Study Abroad
• Chartis
• CMI Insurance Specialists
• Combined Insurance Company of America
• Combined Life Insurance Company of New York
• Companion Life
• Delos Insurance Company
• Fairmont Specialty Group
• Gerber K-12
• Gerber Special Risk
• Guarantee Trust (GTL)
• Health Advocate Alliance – Accident (ACE)
• Health Advocate Alliance – Accidental Death (ACE)
• Health Advocate Alliance – Critical Med (ACE)
• Health Advocate Alliance – Dismemberment (ACE)
• ISM
• National Employers Association (Chubb)
• National Guardian Life
• The Ohio International Intern Program
• QBE
• Shared Services Insurance Group, Inc.
• Sobel Camper
• UCAA – Safeguard STM (Starr)
• United States Fire Insurance Company
• Value Benefits Association (Chubb)
• Wholesale Benefits of America (Chubb)