Medical claim forms
Need to file a new medical claim? It’s quick. If you’re enrolled in the Premier Plan, the Contribution Plan, the Saver Plan, the Select Local Plan, or the other Local Plans, look for the name of your administrator on your plan ID card and follow these instructions to find the right form.
Were you unable to use your plan ID card at a network pharmacy? Did you disagree with the amount you were charged? Then file a pharmacy claim. It’s simple and quick. For questions or help, contact OptumRx at 844-705-7493
With Delta, the good news is that you can ask your network dentist to file a claim for you. If you need to file a claim yourself, use this claim form. For questions or help, contact Delta Dental at 800-462-5410.
- Short-term disability claim
To start a claim for either short-term disability basic or enhanced, contact Sedgwick at 800-492-5678 or go to viaOne express.
- Long-term disability (LTD) claim
To start a claim for either long-term disability basic or enhanced, contact Lincoln at 800-492-5678 or visit the Lincoln website.
Other insurance programs
- Life insurance claims
For information, help, to file a claim, or to request an accelerated benefit, call Prudential at 877-740-2116
- Accident insurance brochure (PDF)
Learn about accident policies that can help supplement your existing medical insurance.