Claim Center

Find a Form

Need a form or claim information? You’ll find everything you need here.

Stop Loss Insurance

To submit a Specific Stop Loss claim:

  1. Complete the 50% notice or reimbursement request below, depending on the claim status.
  2. Submit the completed form to the address shown on the form, along with any required documentation.

To submit an Aggregate Stop Loss claim:

  1. Complete the Aggregate monthly report below.
  2. Submit the completed form to the address shown on the form, along with any required documentation.
Form Last Revised
Stop Loss 50% Notice 10/16
Stop Loss Reimbursement Request 5/15
Aggregate Monthly Report/Reimbursement Request 6/15
Continuing Eligibility Questionnaire 10/16

Questions?

Amy Hartigan, Director of Claims
T: (609) 584-4602
E: AHartigan@BerkleyAH.com

Accident Insurance

To submit an accident claim:

  1. Your employer, group, or association will provide you with a claim form for your coverage.
  2. Submit the completed form to the address shown on the form, along with any required documentation.

Electronic Funds Transfer

To have claim reimbursements deposited directly into your bank account:

  1. Complete the Automated Clearing House (ACH) form below.
  2. Submit the completed form to the address shown on the form, along with any required documentation.
Form Last Revised
Automated Clearing House Authorization 04/15

If you want deposits made to an account other than a checking account, please send an approval letter from your bank, instead of a voided check.

ccSTAT Cost-Containment Services

To request services from ccSTAT:

  1. Complete the referral form below.
  2. Submit the completed form to the address shown on the form, along with any required documentation.
Form Last Revised
ccSTAT® Referral 10/15

Third Party Administrators

To work with us as a Third Party Administrator (TPA):

  1. Complete the TPA Questionnaire below.
  2. Submit the completed form to your Berkley Accident and Health representative, along with any required documentation.
Form Last Revised
TPA Appointment Questionnaire 07/15