- Download a claim form below. The form must be filled out completely, signed, and returned to Kaye Castro, Associate Dean of Finance, Facilities and Student Administration. Ms. Castro will submit the claim form to Relation.
- Obtain a detailed billing statement, complete with treatment and diagnosis codes. Balance due statements cannot be used.
- Obtain your primary insurance Explanation of Benefits (EOB). This accident-only insurance plan is for charges “in excess” of what your own insurance pays. All claims must be filed with your primary insurance first. The primary insurance EOB is needed to see the remaining balance after insurance. This balance is what the accident policy reviews.
- Submit all detailed billing statements and your primary insurance carrier’s EOBs to:
Relation Insurance Services
PO Box 25936
Overland Park, Kansas 66225
Fax: (913) 327-7520
Keep copies of all the documents you submit. To check the status of a claim you submitted, contact Relation at (877) 246-6997 or email firstname.lastname@example.org. It is advisable to wait 10 business days after the submission of your claim before making in inquiry. Please note: In most cases, the medical provider will submit the insurance bill and EOB for you.
Confidential Communication Request
If you would like to have confidential medical information from the claims administrator sent to an address other than the address on file with your school, you can download a Confidential Communication Request, fill out the form, and send it to the address listed. This form is available below.