Summit America Insurance Services
1 - 8 0 0 - 9 5 5 - 1 9 9 1      CONTACT US
Colleges & Universities Students & Participants Liability Programs
Accident and Sickness Insurance

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
PO Box 25936
Overland Park, KS 66225-5936

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

College Accident and Sickness Claim Form (92K PDF)* • download now
Washington State Service Corps Claim Form
(92K PDF)*
• download now
The Corps Network Prescription Drug Claim Form
(124K 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.)