Forms

Forms

Use this form to file a medical claim in order to be reimbursed for all covered medical benefits which you have already paid out of pocket.

Use this form to file a medical claim in order to be reimbursed for all covered prescription benefits which you have already paid out of pocket.

The Authorization to use or disclose health Information form gives us permission to discuss only the specified medical condition with your Personal Representative, and/or specific groups and organizations as indicated on the form.

The Personal Representative Appointment Form gives us permission to discuss any and all medical conditions with your Personal Representative, throughout the school year.This form is filled out once and is good for every injury/sickness for the entire school year.

Need Support or Answers?

Check out our FAQ page, Phone: 1-888-251-6253 or click below

Need Help?
  • Need an ID Card?

    Once you have access to MyAccount, you can print your ID card instantly. This card will have everything you need, including: your name, policy number, and ID number.

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  • Review Brochures and Flyers

    You will find everything you will need to know about your policy in your plan brochure such as eligibility, effective and termination dates, plan benefits, any exclusions or limitations, and instructions on how to file a claim.

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  • Find a Doctor, Hospital or Lab

    Welcome to the Find a Doctor, Hospital or Lab Center! Whether you're looking for a doctor, hospital, laboratory, or even medical equipment and supplies, we have the information you need.

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