school has purchased accident coverage to protect all students involved in any
school sponsored activities including sports against accidental injury or death occurring while the policy is in
force. Coverage is provided by Zurich
Insurance Company and administered by Bollinger, Inc. Usual & Customary benefits are provided
on a full excess basis.
your primary medical coverage is 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 may be denied.
Following is an example of how a Full Excess claim is
handled. A student incurs medical
expenses of $100.00 for treatment of an injury sustained during recess. The student’s parents have private group
insurance. The medical bills must first
be submitted to the parent’s insurance, being the primary carrier. The primary insurance pays $65.00 of the bill
and sends an explanation of benefits (EOB) to the parents. The parents then submit a copy of the
original bills along with a claim form and the primary insurance EOB to Bollinger, Inc., who may then
pay up to $35.00 (the amount of covered expense that is “in excess of medical
expense paid by another plan providing medical benefits.”)
case of accident, notify the school immediately. You may obtain a claim form from the school
or you may download one from www.BollingerSchools.com.
- The claim form
must be submitted within 90
days from the date of accident.
- Treatment must
commence within 90
days from the date of injury.
itemized bills (CMS-1500
form for physicians & UB-04 forms for Hospitals) showing
treatment, dates of treatment, and charges.
Balance due bills will not be accepted.
- Attach copies
of the corresponding primary insurance’s explanation of benefits (EOB).
- If there is no
primary insurance through the parent or guardian’s employer, a statement of
verification from employer on their letterhead must also be submitted.
- Itemized bills
and explanation of benefits must be submitted within 90
days from the date of treatment.
additional bills and EOB’s to: Bollinger, Inc.,
P. O. Box 1346, Morristown, NJ 07962.
- Please note
the name of school district on all bills and correspondence. NO ADDITIONAL CLAIM FORM IS NECESSARY.
- It is the
parent’s responsibility to complete Part I of the claim form and submit the
claim form to Bollinger Inc.
- Do NOT leave original claim form
at the hospital or physician’s office.
- You may
provide copy of the claim form to the hospital or physician’s office so they can
bill Bollinger directly.
- Any questions
regarding claim reporting or issues with the processing of claims through
Bollinger, contact 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
- If you have
any questions, once your claim has been submitted and processed by Bollinger, please
call the Bollinger the Claims Department toll free at (866) 267-0092.