The annual Master Policy renewal occurs on January 1.  This insurance coverage applies on an excess basis only.  The participant's personal health insurance policy will primarily cover accident and sickness claims.  This excess accident medical policy will cover any out-of-pocket expense not paid by the participant's personal health insurance up to the limits of the policy (see Coverage Benefits table below).  This includes payment of the deductible and coinsurance amounts if applied under the participant's personal health insurance policy.  For accidents, the first expense must be incurred within 180 days of the accident.  

If the participant does not have personal health insurance coverage, this excess accident medical insurance policy will pay first dollar, up to the limits of this policy.  

This policy does not cover pre-existing conditions.  A pre-existing condition is any condition for which a prudent person should have sought treatment or was treated in the previous six months. 

Coverage Benefits*

*The coverage benefits described on this website are a summary of benefits only; please contact the University of Kentucky Risk Office to reference the policy for specific information on policy coverage and exclusions.

There are two options to apply for coverage for your Camp/Activity.

Option 1: Click on the “Apply Now” button anytime to complete the simple online form that will automatically provide you with a quote and an invoice for your Camp/Activity.

Option 2: Click on the “Quote Request Form” button to download the Excess Accident Medical Request form. Complete and sign the form and email it to AMBA at [email protected] or fax it to us at 1-515-365-3005. If you have questions, our service center is available at 1-866-838-9536 from 8am-5pm (CT), Monday- Friday. Please allow a minimum of 3 business days for processing.

Once we receive your request, we will email a quote with an invoice to the applicant’s email address. The quote must be signed and returned to AMBA at [email protected] before we can take payment and release the coverage endorsement under the master policy.

Regardless of which option above is selected, once the invoice is received, the next step is to process the invoice through the University of Kentucky PRD system using vendor number 384318. The check should be made payable to AMBA. University of Kentucky Procards are not permitted to purchase insurance; any charges will be declined.

If the signed quote was initially emailed or faxed to us, please mail the check and the related invoice to the address below.  If you have not submitted the signed quote, please include it with payment and invoice.
 

Campus-DV1

PO Box 14521

Des Moines, IA 50306
 

Once the payment is processed, a paid invoice will be emailed to the applicant.  The insurance carrier will be notified to issue an endorsement for the Activity/Camp and will email it to the applicant.  Timing of the endorsement issuance will not affect the coverage.

All Camps/Activities that are 1 week or longer in duration must have the following forms completed by a parent or legal guardian prior to participation in the camp: Medical Insurance Information, Medical Authorization, and Consent to Treatment/Insurance Statement.  These forms may be downloaded from the Download Forms button on this page.  Once completed, parents/guardians should submit these forms to the University of Kentucky Department responsible for the Camp/Activity.

If the participant has personal health insurance, that insurance is primary.

The claim form may be downloaded from the Download Forms button on this page.

Part I of the Claim Form should be completed by the Camp Director or other Supervisor. This section of the Claim Form simply documents to the Insurer that an accident or illness has occurred. A copy of the claim form should be kept at the camp for their records. Once Section I is completed by the Camp Director or Supervisor, the form should be given to the camper for completion. Please note: the Claim Form should not be given to the camper until expenses are incurred. 

Part II of the Claim Form should be completed by the camper/claimant or his/her parents. The information given in this section is very important because it will drive the rest of the claims process. If the camper/claimant has primary insurance, copies of the Explanation of Benefits (EOB) forms need to be included with the completed claim form and fully itemized medical bills. 

• If the camper/claimant does not have primary insurance, no EOB will be available. Therefore, just the completed claim form and copies of fully itemized medical bills need to be sent to the Claims Processor, AGIA. Please note: Make sure to instruct the camper/claimant that balance due bills are not acceptable in lieu of itemized medical bills.
• The Authorization to Release Information and Payment Authorization contained within Part II of the Claim Form must be signed by the parent or camper/claimant before the claim form is mailed to AGIA. 

Part III of the Claim Form does not need to be completed by the Physician or Provider if EOB's are included. If the Cigna Plan is Primary, a physician must complete Part III.
 

As referenced above, once the Claim Form has been completed and authorized, the Claim Form, fully itemized medical bills (and EOB's if applicable) should be sent to AGIA; mailing address and other contact information is on the claim form as well as below. As soon as a Dedicated Claims Examiner has been assigned to the plan, his or her name and number will be made available to you in the event of a question on the status of a specific claim. 
 

NAHGA Claim Services

PO Box 189

Bridgton, ME 04009

Email: [email protected]

Phone: 1-800-952-4320

Fax: 1-207-647-4569