The following information is to help you understand the school insurance process for a school-related athletic injury:
Report the injury immediately to the school athletic trainers and the coach.
Please submit ALL bills to your own insurance carrier first.
You will receive a Student Accident Claim Form via email from the school athletic trainers. However, in order to receive the claim form, the injury must be reported in a timely manner to the school athletic trainers and the coach. Athletic injuries sustained while participating in non-Eastern activities will not be covered.
If all bills are not paid by your insurance carrier, or if you have no insurance, attached unpaid bills to the Student Accident Claim Form and mail to:
BMI Benefits, LLC
PO Box 511
Matawan, NJ 07747
Do not leave the claim form at the hospital, urgent care or doctor’s office.
If you do not receive a claim form, please contact the school athletic trainers. The claim form must be submitted within 90 days from the date of injury. Treatment must commence within 90 days from the date of injury.
If you do not have insurance, complete the BMI Benefits Statement of No Insurance, and submit this form along with the completed accident claim form to BMI Benefits.
If your medical coverage is under an HMO or similar plan, you must follow their rules for obtaining benefits. If the HMO is not utilized, benefits otherwise payable under this policy shall be reduced by 50%. If you have any questions on a filed claim, call BMI Benefits at 800-445-3126.
The following is an example of how a Full Excess Claim is handled: A student-athlete sustains an ankle injury while participating in a school-sponsored Eastern athletic program, and incurs medical expenses of $100 related to treatment for this injury. The student’s parents have private group insurance through their employer with Blue Cross/Blue Shield. The medical bills must first be submitted to BC/BS. As the primary carrier, BC/BS pays $65.00 and sends an explanation of benefits to the parents. The parents then submit a copy of the original bills and the explanation of benefits to the school’s insurance carrier who will then pay $35.00, the amount of covered expense that is “in excess of medical expenses paid by another plan” providing medical expenses are within our Plan AA Benefit Schedule.
CLAIM FORM FRAUD NOTICE: In NJ, any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.