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MedCost offices will close at 3:00 PM (ET) on Thursday, July 2, and will be closed on Friday, July 3, in observance of Independence Day. Regular hours will resume on Monday, July 6.
Frequently Used Employer Forms
Claims forms are here for your members. If you have questions, please call our Customer Service Contact Center at 1-800-795-1023.
Medical and Dental Claims Forms
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.
Authorization to Release Information
Members can use the following forms to give MedCost permission to share information about themselves (or a dependent) with another person or organization.
Spending Account Reimbursement (FSA)
Reimbursement forms related to your flexible spending account (FSA).
Weekly Disability Income Claim
Members use this form for short-term disability claims.
