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Medical Related Forms

All of the forms listed on this page are in PDF format. You will need Adobe Acrobat® Reader to view and print these forms. This free software may be downloaded from the Adobe web siteExternal Link.

Medical

 

Insurance

Our Council carries accident and health insurance, through Health Special Risk, Inc. (HSR), on each Scout and adult leader registered in our Council. The cost is included in the camping fees. Out-of-Council units must provide their own accident and health insurance.

In the event a Scout needs medical attention by an outside health care provider all fees and bills should be handled in the following manner:

  • Complete an HSR claim form (available from Camp Health Officer or Council Camping Secretary) from HSR and submit it along with the health care provider’s itemized billing statement directly to HSR IMMEDIATELY. Please follow the directions on the claim form completely. HSR will automatically pay the first $300.00 on every claim. Do not send any completed claim forms and/or bills to the Council Service Center.  HSR Description of Coverage
  • For claims exceeding $300.00: After submitting claim to HSR, submit any outstanding bills to the parent/guardian’s private health insurance.
  • After the parent/guardian’s insurance has paid their maximum limit, the remainder of the outstanding balance (if any) can be submitted to HSR as a continuation of the original claim. You must provide an explanation of paid benefits from the parent/guardian’s insurance along with the claim. Although the claim is originally submitted to HSR, the parent/ guardian’s health insurance is considered primary. HSR will only make payment on claims over $300.00 after proof of payment from the primary carrier is presented.

It is the responsibility of the parent/guardian to ensure that their Scout’s claim (if any) is submitted and satisfied. Please do not ask the health care providers to forward claim information or additional bills to the Council or Camp. In the event there are difficulties with a claim, you may contact the office for information [R1] and assistance (914) 773-1135 ext. 2614.


 [R1]What office is this?

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