Fordham University            The Jesuit University of New York

How to File a Claim


In the event of Injury or Sickness the Insured Person should:

1) Obtain a CLAIM FORM from one of these locations:
Lincoln Center -Office for International Services, 33 W. 60 st. room 306, NYC
Rose Hill Campus- Office for International Services, Fordham Building 540 E. 191st. , Bronx NY
ONLINE through the Claim Administrator, Administrative Concepts, Inc.(ACI) online click here. Follow the link and choose the "COMBINED LIFE INSURANCE COMPANY of NEW YORK" claim form.

1a) Complete a CLAIM FORM electronically (if you do not wish to mail it in):
Visit and choose "Claim Status."  You will be required to create an account, and once you do, you can log in and there will be an option for submitted the claim. If you complete the form electronically, you will still need to mail in your itemized bill to the address below.

2) The physicians and hospitals may submit itemized bills directly to ACI electronically using Payor #22384 or mailing them to the address below.

3) Complete a claim form and mail it to ACI within 15 days of the date of the Injury or commencement of the Sickness, or as soon thereafter as possible. Mail the claim form to Administrative Concepts, Inc., 994 Old Eagle School Road, Suite 1005, Wayne, PA 19087-1802.

4) Claim forms are available online here or by calling 888-293-9229. If the providers have given you itemized bills, attach them to the claim form.

5) Direct all questions regarding benefits available under this Plan, claim procedures, status of a submitted claim or payment of a claim to ACI. ONLINE CLAIM STATUS is available to or by calling 888-293-9229. Select option "2" for Customer Service.

6) Itemized medical bills must be attached to the claim form at the time of submission. Subsequent medical bills received after the initial claim form has been submitted should be mailed promptly to ACI. No additional claim forms are needed as long as the Insured Person's name and identification number are included on the bill.

NOTES: If you bring your Health Insurance card with you to the physician, it should have all the necessary information for the doctor to submit your bill directly to the insurance company.  Generally, it is the provider's (doctor's) responsibility to submit the bill, and your (insured) responsibility to submit the claim form.  However, if you do not have your insurance card with you, you will want to be diligent and receive an itemized bill from the provider, which you will submit with your claim form.

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