Our school has purchased accident coverage to protect all students involved in any school sponsored and  supervised activities including sports against accidental injury or death occurring while the policy is in force.

Coverage is provided by BMI Benefits, LLC. P.O. Box 511 

Matawan, NJ 07747 

Phone: 800.445.3126 Fax: 732.583.9610 

www.bobmccloskey.com 

Usual & Customary benefits are provided on a full excess basis.

If 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.

***Please note that Manchester Township Board of Education’s Student Accident policy with BMI has a $500 deductible. This deductible must be satisfied before benefits will be paid.

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, Specialty Group, who may then apply the balance ($35) owed by the parent to the student accident policy’s $500 deductible. If the deductible has already been met, Bollinger may issue payment to either the provider directly or the parent.

Claims Instructions

In case of accident, notify the school immediately. You may obtain a claim form below.

• The claim form must be submitted within 90 days from the date of accident.

• Treatment must commence within 90 days from he date of injury.

• Attach itemized bills CMS1500 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.

• Forward additional bills and EOB’s to: Bollinger Specialty Group, 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 for processing.

• 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 Stephanie Brown, Claims Advocate at A.J. Gallagher, 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 BMI please call 800-445-3126.