Here are printable claims forms for your convenience. However, it is even easier to submit eForms through your Member account. If you have any questions, please call our Customer Service Contact Center at the number listed on your ID card or access Live Chat.
Requests for enrollment or benefit change forms are made through your company’s benefits administrator or Human Resources department.
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.
Additional forms can be found within your secure Member account (Accident Details, Coordination of Benefits and Subrogation). To access these interactive forms, you must be a registered user and be logged in.