Member Claim Form -
Use this new, interactive form to complete your claims for medical, vision, and medical supplies expense reimbursement. You may enter your information directly on to the form, print it and mail it to us as usual. Tips for using the form:
Edits and calendars will help you enter accurate information.
When you click the new Print Form button on the claim, a message will be displayed if required information is missing.
Hover your mouse over the text fields for helpful information.
If you save the form to your PC, only the blank form will be saved, not the text you entered.