Plan year: August 18, 2007–August 17, 2008

Student Gold Health Insurance Plan

How do I file a claim?

In the event of injury or sickness:

1. Report to Wardenburg Health Center for treatment or referral.
2. If you are more than 50 miles away from Wardenburg Health Center, go to your physician or local hospital.
3. Mail all medical and hospital bills to the address below, along with the patient's name and insured student's name, address, student ID number, and name of the university under which the student is insured. A company claim form is not required for filing a claim.
4. File the claim within 30 days of the injury or first treatment for a sickness. Bills should be received by the company within 90 days of service. Bills submitted after one year will not be considered for payment except in the absence of legal capacity.
5. You may also bring your bill to Wardenburg Health Center, room 251

Submit all medical claims or inquiries to:

Chickering Claims Administrators, Inc.
P.O. Box 15708
Boston, MA 02215
888-834-4708
www.chickering.com
Policy # 697421

For pharmacy benefits call:

Aetna Pharmacy Management
800-238-6279

Prescriptions should be filled with an Aetna-participating pharmacy.