Claims forms are here for your members. If you have questions, please call our Customer Service Contact Center at 1-800-795-1023.
If you received care or a bill from an out-of-network provider, use these forms to submit a claim for reimbursement or to request coverage.
Members can use the following forms to give MedCost permission to share information about themselves (or a dependent) with another person or organization.
Reimbursement forms related to your flexible spending account (FSA).
Members use this form for short-term disability claims.