|The forms below are provided by our Industry Alliances;
To make an Extended Health Care and/or Dental claim, complete, attach receipt and submit the appropriate form to the address provided on each form.
If your plan requires your Group Plan Administrator to provide an authorizing signature, be sure to obtain the signature before submitting your claim.
Benefits are adjudicated based on the details provided on your claims forms.
Incorrect or incomplete information may result in denial or improper payment of your claims.