Illinois State University Insurance Form

309 438 2515 aetna life insurance company noncompletion of this form may result in delay denial.

Illinois state university insurance form. If other insurance exists attach payment denial school illinois state university policy number 711123 student name. Illinois state university campus box 2540. An itemized bill from the provider of the service. Ub92 or ub04 billing from a hospital.

Monday friday 8 00am 4 30pm. Eligible employees may choose to participate in one of the several available health plans. For the health and safety of students and staff student health insurance requests customers to please call 309 438 2515 and to mail student insurance campus box 2541 normal il 61790 or fax medical claims if possible. A completed aetna claim form.

These forms are downloadable and available in adobe portable document format pdf. Student health insurance certification forms. Accepted forms are hcfa 1500 billing from a physician. Illinois state university office of student health insurance campus box 2541 normal il 61790 telephone.

An explanation of benefits from your other insurance carrier s. The risk management and insurance major at illinois state university is a premier nationally known curriculum that prepares students for careers in insurance and risk management the risk management and insurance sequence provides an in depth study of insurance and financial services combined with the general business core curriculum. 2020 professional practice student health insurance certification form use for fall 19 spring 20 and summer 20.