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Product Guide
Accident and Sickness Insurance
Claims

Download, print, and complete the appropriate form below to submit a College Accident and Sickness claim.

Mail completed forms to:
Summit America Insurance Services
Attn: Claims Division
7400 College Boulevard, Suite100
Overland Park, KS 66210

A representative of our staff will respond to your request promptly.

College Accident and Sickness Claim Form (92K Enterable PDF)* • download now
College Accident and Sickness Claim Form -- Colorado State University - Ft. Collins
(72K PDF)*		 • download now
Washington State Service Corps Claim Form
(92K Enterable PDF)*		 • download now
NASCC Prescription Drug Claim Form
(36K PDF)*		 • download now
Authorization to Release Information
(24K PDF)*		 • download now
Claim Filing Instructions (16K PDF)* • download now

Submit a Claims question
* PDFs require Adobe Reader v.6.0 or later.
(Enterable PDF forms can be filled out electronically.
Data entered electronically CANNOT be saved.
To keep a copy, please print your completed form.)
Summit America Insurance | info@summitamerica-ins.com Copyright 2007 Summit America Insurance Services, LC
Overland Park Office
7400 College Boulevard, Suite 100
Overland Park, KS 66210
1-800-955-1991		 Salt Lake City Office
2180 South 1300 East, Suite 520,
Salt Lake City, UT 84106
1-800-955-1991 ext. 198		 All Rights Reserved. Terms of use