ARLINGTON HEIGHTS YOUTH ATHLETIC ASSOCIATION

INSURANCE CLAIM PROCEDURE FOR INJURED PARTICIPANT

Arlington Heights Youth Athletic Association provides each participant with Excess Medical coverage.  This insurance, administered by Loomis Benefits West, will cover out of pocket expenses (e.g., deductibles and co-pays) after the injured participant’s primary health insurance has paid its benefits.

We have found that the quickest way to get your out of pocket expenses paid is to provide the health care provider with the excess information at the same time that the primary health insurance information is presented.  This will allow the health care provider to send the necessary forms directly to Loomis Benefits West.  We have put all the information you will need in card form that can be kept with your primary insurance card.

If you did not provide the health care provider with this information at the time of the accident, you will need to ask them to send Loomis two forms:  a UB92 and a HCFA 1500.

If you have difficulty obtaining these forms from the health care provider, please contact Linda Landsberg at Maine Insurance Agencies (ph: 847-827-1234 or email: llandsberg.maine05@insuremail.com) and she will assist you in obtaining them.

After you receive an explanation of benefits (EOB) from your primary health insurance company, print the QBE Ins Corp Notification of Injury forms from the AHYAA website (www.AHYAA.org).   Complete these forms, have them signed by Barb Pingel at the AHYAA office, and then fax them to Loomis Benefits West at:  610-373-9707

The process takes approximately four weeks.  If you haven’t heard from Loomis within that time, contact Linda.