Notice
Friday, April 3: Our Customer Service center will be closed in observance of Good Friday. To view benefit information and claim status at any time, you can sign into your account or use our Interactive Voice Response System 24/7 at (800-452-9310).
Standard Forms for Brokers
Easily access and download the standard forms and applications you need.
Authorization Form Granting Access to PHI - Insured Clients (PDF, 3 pages, 52kb)
Authorization Form Granting Access to PHI - Self Funded Clients (PDF, 3 pages, 51kb)
