5071 WEST H AVENUE | KALAMAZOO, MI 49009 | 269.381.6630
Home
Products
College Athletes: 1st Care Plan
College Student Accident and Sickness Coverage
College Student Personal Property & Liability Renters Insurance
FREE Prescription and Dental Discount Plan
Intercollegiate Sports Coverage
International Insurance (including Travel Coverage)
Preschool/K-12 Blanket Accident Coverage
Preschool/K-12 Voluntary Accident Coverage
Short Term Medical Care & Individual or Family Health Plans
Short Term Medical Care
Individual or Family Health Plans
Sport Camps / Special Risk Coverage
Forms
Authorization Release Form
Submit Online
Download PDF
Claim Forms
Intercollegiate Sports Claim: Submit Online
Intercollegiate Sports Claim: Download PDF
K-12 Claim Forms
Voluntary Coverage Claim (All States except Minnesota)
Voluntary Coverage Claim (Minnesota)
HIPAA Privacy Notice
Information Request Forms for College/K-12 Administrators
College Sports
Student Health Insurance
K-12 Coverage
Sports Camps & Special Risk
Parent Information Form
Player Census Form
Submit Online
Download PDF
About Us
Contact Us
You Are Purchasing:
Quantity:
1
Description
:
Washington Academy - ME - At-School Standard: Excludes 10-12 Ftb (WASHACA-01)
Price
:
39.00
Total:
39.00
Continue
© Gallagher 1999 - 2025.
Legal Information
Terms of Use
Privacy Policy
Compensation Disclosure