Student Health Services

Claim Form

To file a claim:

1. Obtain a claim form from Collegiate Risk Management or 1-800-422-3420 or
   HCH Administration Inc.
   P.O. Box 1986
   Peoria, IL 61656-1986
2. Complete the form.
3. Submit all claims, including itemized bills, to:
   Student Health Services
   051 Student Union
   Wright State University
   3640 Colonel Glenn Hwy.
   Dayton, OH 45435-0001
4. Written proof of loss must be furnished within 90 days after the date of such loss.

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