PLEASE NOTE: This is a student accident excess or supplemental benefit plan, NOT a comprehensive, major medical health insurance plan/policy nor an alternative to a major medical health insurance plan/policy. Plan benefits are limited and may not provide 100% Coverage, especially if your primary insurances’ annual out of pocket deductible or co-insurance requirements have not been met.

FULL EXCESS – Benefit eligible/covered expenses will be paid only when they are in excess of other valid insurances. Your medical provider must file your claim with all other available and collectible insurances prior to filing with ADL. Please provide all medical providers where treatment was/will be received with ADL Risk Services’ billing address and contact information, as your secondary, excess, student accident medical insurance, to be billed directly once any applicable primary/other insurance has paid. The medical provider must submit the CMS-1500 and/or UB-04 form along with your primary insurance Explanation of Benefits (EOB). Please read the Accident Medical Claim Filing Instructions thoroughly and completely prior to submitting this form or filing any claims. Benefits for eligible expenses will be paid per Benefit Plan terms.  The STUDENT ACCIDENT FORM (SAF) must be submitted within 90 days from the date of injury. Treatment must commence within 30 days from the date of injury by a licensed medical doctor. Each injury has a one-year (52 week) benefit period. Do not rely on the provider or any other party to submit your SAF. You are responsible for submitting your SAF to ADL! NO ADDITIONAL ACCIDENT FORM IS NECESSARY TO OPEN YOUR CLAIM THROUGH ADL.