NXG Montana Health Credit Union

Are you ready to submit a claim? We have made it a breeze to submit online, just fill out the claim form!

⇢ Policy Summary - Terms and Conditions

For questions regarding claims, please call
(877) 210-7401

File a Claim

Remember, claims should only be submitted on phones that are active as shown on your mobile device wireless bill for the previous month.

Incidents for accidental damage and mechanical failure that occur prior to, or in the 30-day waiting period are not covered.

Policy / Device Information

Device Type

Device Make

Device Model

Device Serial Number

Device IMEI

Device Color

Memory (GB)

Service Carrier

Claim Information

Date of Loss

Type Of Loss

Police Report (Fire)

Police Report (Theft)

Police Report (Vandalism)

Date of Police Report

Officer First Name

Officer Last Name

Officer Contact Number

Report/Case #

Description of Incident

Known Damage to the Unit

Contact Information

Enter the name and address of the person we should contact.

First Name

Last Name

Email Address

Phone

Address Line 1 Provide the address where reimbursement checks should be sent (if applicable)

Address Line 2

City

State

Zip

Certification Statements

Check boxes to confirm

I certify the covered device was fully operational and not damaged as of the date I first became eligible for participation in the Covered Group.

I certify the covered device was fully operational and not damaged within the 30-day waiting period.

I certify the covered device was not repaired or replaced prior to this claim submission.

To prove ownership, I agree to submit a copy of my wireless phone bill from the previous month showing my device had activity on the account.

Disclaimer & Digital Signature

Digital Signature

We must advise you that any person who knowingly and with intent to defraud any insurance company files a statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact thereto, commits a fraudulent insurance act, which is a crime and may be prosecuted to the full extent of the law. By signing, I agree that the statements above are true and correct to the best of my knowledge and cannot be changed once submitted to the company.

Check this box to acknowledge that you have read and agree to the above Disclaimer

I Agree

Worth Ave. Group is the industry leading provider of personal property and electronic device insurance and extended service plan coverage. With over 50 years of experience, you can expect the most comprehensive coverage options available on the market, paired with exceptional customer service.

Since 1971

Mailing Address: P.O. Box 2077, Stillwater, OK 74076-Physical Address: 1337 S. Western, Stillwater, OK 74074
Email : [email protected]
Phone : 1-800-620-2885