Use these forms to submit a health or dental claim
These forms are in PDF format and can be downloaded to and then printed from your computer with Adobe Acrobat Reader. If you do not have this free software installed on your computer, install it now. Once installed, it can be used to read many documents throughout the Web.
Submit Your Form
Remember to sign the form and attach any necessary receipts. Then submit to your plan administrator, if that's who usually signs your forms. Otherwise, mail your form to the address shown on the form.
For SecureServe Plan Members Only
Access your custom forms by clicking this link.