Web2024 NJ Bollinger Schools Student Accident Claim Form [2024] 2024. 4.8 Satisfied (220 Votes) 2024 NJ Bollinger Schools Student Accident Claim Form [2024] 2024. 4.6 … Web1. The student (not the Doctor or Hospital) must submit a fully complete and signed claim form within 90 days of an injury. Only one form is needed for each injury. 2. Subsequent bills must be submitted within 90 days of the date of service and should clearly indicate Patient Name, Name of College /University or Policy Number and Diagnosis. All ...
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WebComplete & Return this Form to: Medical/Dental Accident Claim Form 90/10 co-insurance 52-week benefit period Individual Registration P.O. Box 1322 Morristown, NJ 07960 5. NAME OF LEAGUE AND NAME OF TEAM: CLAIMANT IS A: YOUTH COACH/MANAGER OTHER: 6. MSR-CF-BOLL (01/15) Rev Oct. 2015. Marked set by msscarola. Marked set … WebIn addition, Robbinsville Schools offers parents the option of purchasing a voluntary student accident insurance policy through Bollinger Specialty Group. Types of coverage offered … bytecode logo
Dental Accident Claim Form
WebBollinger directly. Any questions regarding claim reporting or issues with the processing of claims through Bollinger, contact Stephanie Brown, the Student Accident Claims Coordinator for Gallagher O’Gorman & Young, the School District’s Insurance Agent, by phone at (888) 232-9262 or claims fax (609) 924-9221 Webfiling a claim: 1. THIS CLAIMFORM MUST BE MAILED TO BOLLINGER WITHIN 90 DAYS OF THE DATE OF ACCIDENT. Please be sure that: a) The school official has completed … WebStudents at Montclair State (SAMS) - Junior Program; Students at Montclair State (SAMS) - Senior Program; Summer Credit Recovery (Summer Remedial School) ... Bollinger Student Accident Claim Form; 333 Colfax Avenue. Clifton, NJ 07013. Get Directions. P: 973-470-2312. Absentee Line: 973-470-2427. Site Map. User Options. byte code means in python