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Forms

If you need assistance completing any forms or have any questions, please call Member Services at 1-800-565-8215, Monday – Friday, 8:30 a.m. to 5:00 p.m. (Eastern). A translation line is available for most languages.

 

Medical Claim Form

Term Life-ADD Form

Termination-Loss of Coverage Claim Form

Discounts

Discount program

PAI HIPAA Forms

HIPAA-all groups