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.
FormLast Revised
Stop Loss 50% Notice9/18
Stop Loss Reimbursement Request9/18
Aggregate Monthly Report/Reimbursement Request9/18
Continuing Eligibility Questionnaire9/18
ACH Claim Reimbursement Authorization12/18

Questions?

Amy Hartigan, Director of Claims
T: (609) 584-4602
E: [email protected]

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.
FormLast Revised
Automated Clearing House Authorization12/18

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.

Berkley Edge Cost-Containment Solutions

To request services from Berkley Edge (formerly ccSTAT):

  1. Complete the referral form below.
  2. Submit the completed form to the address shown on the form, along with any required documentation.
FormLast Revised
Berkley Edge Referral (formerly ccSTAT)9/18
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.
FormLast Revised
TPA Appointment Questionnaire07/15

Insurance coverage is underwritten by Berkley Life and Health Insurance Company and/or StarNet Insurance Company, both member companies of W. R. Berkley Corporation and both rated A+ (Superior) by A.M. Best. Not all products and services may be available in all jurisdictions, and the coverage provided is subject to the actual terms and conditions of the policies issued. Payment of claims under any insurance policy issued will only be made in full compliance with all United States economic or trade and sanction laws or regulation, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”).