Parents Voluntary Accident Insurance
To purchase this additional coverage, please download and print the enrollment form and return to A-G Administrators along with payment.
*The School’s insurance will pay 80% of reasonable and customary expenses incuned for necessary medical, dental or hospital care within one year from the date of injury up to a maximum of $30,000, less a $100 deductible and the amount covered by other insurance. Initial care by a licensed physician or surgeon must be within 30 days of the injury. Please note, however, that the policy will not cover expenses related to illness or disease in any form.
- What does the policy cover?
- What is the name of the insurance company for the policy?
- Who administers the claims?
- Can I purchase additional insurance?
- How do I process a claim?
The insurance policy provides coverage for:
· Accident Medical or Dental expenses for covered injuries sustained during the hours and days when school is in session and while insured students are participating in school supervised and sponsored activities and interscholastic sports. The insurance policy will pay 80% of reasonable and customary expenses incurred for necessary medical, dental, or hospital care within one year from the date of injury up to a maximum of $30,000, less a $100.00 deductible and the amount covered by your insurance. Initial care by a licensed physician or surgeon must be within 30 days of the injury. Please note, however, that the policy will not cover expenses related to illness or disease in any form.
· The Parents’ Voluntary Accident Extension Insurance provides coverage 24 hours a day while your son is at home or not under the care and direction of the School. You can purchase this additional coverage for $124.00 annually at the beginning of each school year.
The first step is to complete and sign a claim form. This enables A-G Administrators to open a claim for the treatment of the injury. To avoid delays in the claim processing, please be sure that the ”other insurance” (your insurance) portion of the claim form is completed in full. The claim form must be signed by a school official.
Complete the top part of the form, provide your health/dental insurance information, and sign as applicable in the spaces provided; a Gilman School official does need to sign off on the form. Forward to the address at the top of the form immediately; the address is also listed below (please make copies of all documents).
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. They typically require a CMS-1500 (HICF) or UB04 form from the provider (they will know what these are). Account statements or “balance due” statements are helpful, but do not contain all the information needed to process the charges.
If you do not have any bills at the time of submitting the claim, please submit a copy of all bills pertaining to the claim as they are received. A representative may contact you via mail/phone to obtain further information.
Explanation of Benefit (EOB) Statement
If you have other medical insurance, all medical bills must be first submitted to that carrier for their determination of eligibility. If the charges are not paid in full by your medical insurance provider/carrier we will need to see a copy of the “Explanation of Benefits” (EOB) from that carrier prior to issuing benefits from this office. If you have no primary medical insurance, the need for an “EOB” will not be applicable to your claim.
Providing a copy of your Explanation of Benefit (EOB) statement will ensure that your claims are paid.
The required documents (claim form, Itemized bill, EOB) can be emailed, uploaded through the secure A-G online portal, faxed, or mailed to:
A-G Administrators, Inc.
P.O. Box 979
Valley Forge, PA 19482
Fax: (610) 933-4122
Phone: (610) 933-0800
Toll-Free (800) 634-8628
To check claim status, go to: