If you need assistance completing any forms or have any questions, please call Essential StaffCARE customer service at 1-866-798-0803. Representatives are available Monday through Friday, 8:30 a.m. to 8:00 p.m. Eastern Time. A translation line is available for most languages.
Authorized Representative Form / Formulario de Representante Autorizado
Prescription Drug Claim Form
Prescription Drug Claim Form (5500 Plan)
Medical Claim Form / Formulario de Reclamo de Gastos Médicos
Wellness and Preventive Reimbursement Claim Form
Accident Questionnaire-ESC 5500 Plan
Coordination of Benefits-ESC 5500 Plan
Dental Claim Form
EyeMed Out-of-Network Claim Form
Missed Premium Direct Payment Form / Formulario Para el Pago Directo de Primas no Cubiertas
Short-Term Disability/Proof of Loss Form
HIPAA-all groups