File a Claim

For a smoother process, first contact the medical provider of service that treated the student to submit the bill to your primary insurance carrier. Then have the medical provider add this student accident insurance to the student’s account as secondary insurance so the provider can bill this plan as well. If there is NO primary insurance coverage, continue to the next steps below.
Once that’s complete, download the KidGuard® claim form below and submit it within 90 days of your child’s accident.
● Part A is to be completed by you.
● Part B is to be completed by your child’s school.
Attach supporting documentation (if the provider of service will NOT bill insurance carrier).

Itemized medical physician or hospital bills:
1. HCFA-1500 (standard form used by Medical Providers; sample attached)
2. UB-04 (standard form used by Hospitals; sample attached)
3. ADA Dental form (standard form used by Dental Providers; sample attached)
**Balance due statements will not be processed.If you already paid the medical or hospital bill, include a paid receipt or a copy of your cancelled check at the same time you submit the claim form. Otherwise, payment will be made to the provider of service (Physician, Hospital or Others).

Explanation of benefits (EOB) is a statement from your primary health insurance company that explains what medical services were paid for on your behalf. The EOB should show, the name of the provider that rendered the service, date of service, amount billed, allowed amount, non-covered, and the patient’s responsibility, such as copay, deductible, or coinsurance -(sample form attached)
Submit your claim form and supporting documentation:
Email: contact@kidguardinsurance.com
Fax: (407) 798-0296
Mail: KidGuard®, P. O. Box 784268, Winter Garden, FL 34778-4268

download claim form

Download Claim Form (Spanish)

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