A-G Specialty Insurance is Now the Claims Administrator for the NCAA PEI Learn More
Submit the claim forms by following the links below to start the A-G claims process for the treatment of injury. Be sure to include all itemized bills and an EOB from your insurance carrier.
A-G Specialty Insurance requires 3 things to process a claim:
1. Completed and Signed Claim Form
2. All itemized Bills
3. Explanation of Benefits (EOBs) from your Primary Insurance Carrier
Consult our FAQ section if you have further questions on these documents.
The claim form enables A-G Specialty Insurance to start the process for the treatment of injury.
To avoid delays in claim processing please be sure the “other insurance” portion of the claim form is completed in full. The claim form must be signed by an organization’s official such as an administrator, coach or athletic trainer.
A-G Specialty Insurance requires all provider invoices that apply to the injury.
Please include copies of all medical bills, showing the name and address of the provider of service, date of service, type of service and charges. We 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.
To view a sample of an itemized bill, click on the link below:
Explanation of Benefits defines coverages from other health insurance providers.
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 the other medical insurance carrier, A-G Specialty Insurance will need to see that carrier’s EOB prior to considering eligibility for benefits. If you have no primary medical insurance, the need for an “EOB” will not be applicable to your claim.
Once you have all documents completed and in order, you can submit your claim via one of the following:
1. Upload documents through our secure portal:
2. Or, mail to:
A-G Specialty Insurance LLC
Attn: Claims Department
P.O. Box 21013
Eagan, MN 55121
For Indiana Residents Who Purchased an Accident and Sickness Product and those covered by a Blanket Accident and Sickness Policy issued in Indiana: You may at any time ask Us or Our Administrator for an estimate of the amount We will pay for or reimburse to you for nonemergency health care services that have been ordered for you. You may also ask Us or Our Administrator for the applicable benefit limitations that apply to the ordered nonemergency health care services you are entitled to receive under your coverage. The law requires that an estimate be provided to you within five (5) business days.
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