How Do I Submit a Claim?
You must complete, sign, and submit a Claimant's Statement and Authorization form along with proof of claim (itemized bills, payment receipts, medical records, police reports, etc.) for every incident. (Click here to download the form in Spanish).
Filing a Claim on Behalf of Someone Else? If you are filing this claim on behalf of another person, you MUST fill out the section of the Claimant's Statement and Authorization form labeled "Supplement D - Authorization Form for Use and/or Disclosure of Protected Health Information" – also known as a HIPAA form. This section must be signed by the policyholder in order for us to speak with you regarding any of the policyholder's Protected Health Information (PHI). Without this signed form, we may only disclose to you the status of the claim.
You can complete and submit the Claimant's Statement and Authorization form along with supporting documents in one of the following ways:
Via DocuSign within Member Portal (Most Efficient Approach)
1. Go to Member Portal (formerly Client Zone / Student Zone).
2. Log in to your account. If this is your first time using Member Portal, please click here to view instructions for registering your new account.
If you already have a Client Zone / Student Zone account, you do not need to register for a Member Portal account. Simply log in to Member Portal using your Client Zone / Student Zone login details.
3. Click "Claims and Appeals" in the main navigation menu.
4. Click “Submit New Claim Via DocuSign” button under the “Claimant’s Statement and Authorization Form” subheader in the “File a Claim” section and follow the instructions.
For more extensive step-by-step instructions, including screenshots, please see our Claims Guide.
Don’t Have Access to the Claims and Appeals Page? If you noted that you are not the insured or the insured’s legal guardian, you will see the Protected Health Information Authorization page in place of the Claims and Appeals page. Enter the insured’s email address and click “Send Request.” Once the insured has completed and submitted our HIPAA form, you will gain access to the Claims and Appeals page and have the ability to submit a claim within 3-5 days.
By Mail
1. Download the Claimant's Statement and Authorization form. (Click here to download the form in Spanish.)
2. Print, complete, and sign the form.
Mail to:
WorldTrips Claims Department
PO Box 240358
Apple Valley, MN 55124
U.S.A.
WorldTrips is also happy to fax, e-mail, or mail the form(s) to you upon request.
Important Note for Students
For eligibility purposes, you must submit the following along with a Claimant's Statement and Authorization form:
- A copy of your education-related visa (F-1, J-1, OPT, etc.) or valid I-20/DS2019
- Proof of full-time student status (not necessary if submitting a valid F-1 visa including OPT, or J-1 visa)
