Bollinger Claim Forms 2025

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49 votes

The document is a Student Accident Claim Form for the 2019-20 school year, intended for parents or guardians to report and claim medical expenses related to student injuries occurring during school-sponsored activities. It includes sections for personal information, details of the accident, medical authorizations, and instructions for submitting the claim. The form emphasizes the need for accurate information to avoid fraud and outlines the process for filing claims with Bollinger Inc.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (158 Votes)
2019	4 Satisfied (49 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the difference between CMS 1500 and UB-04 claim forms?

For example, if a surgeon performs a procedure in a facility such as a hospital or ASC, a CMS-1500 will be submitted for the surgeons services only, while a separate UB-04 form will be submitted for the use of the facility. Both forms will be needed to fully bill out for a procedure.

What are the different types of claims?

Definition: Claim documents are the essential documents that the insured needs to submit to the insurance company for processing the claim further. This document includes the details that help the insurance analyse the loss and take the decision to settle the claim.

What are claims made forms?

The claims-made form covers incidents that you report during the active policy period or during an extended reporting period and occur after a policys retroactive start date.

What type of insurance is Bollinger?

Bollinger Specialty Group, has been proudly administering Student Accident Insurance for over 70 years. We have become known as a leader in the industry with experience protecting over 36 million students since 1946. We have built strong relationships with several carrier partners.

What are the claim forms?

Claim Form legal definition: A claim form is defined as a formal written request to an insurance company, the government, or other entity for compensation you believe you are entitled to under their rules or statutes.

What are the two types of claims forms?

These forms capture essential information about the patient, service details, diagnosis, and charges. Heres an overview of some common types of medical claim forms used: Institutional Claim Form (includes 837I, UB-04 Form) Professional Claim Form (includes CMS-1500, 837P)

Bollinger Claim Forms 2025

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