Skip to content

Flexibale StaffCARE Logo

Forms

If you need assistance completing any forms or have any questions, please call Flexible StaffCARE customer service at 1-844-262-6027. 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.

General Forms

Authorized Representative Form / Formulario de Representante Autorizado

Medical Claim Form (Indemnity Plan) / Formulario de Reclamo de Gastos Médicos (Plan de Indemnización)

Prescription Drug Claim Form / Formulario de Reclamo de Recetas Médicas

Limited Benefits Forms

Dental Claim Form

Missed Premium Direct Payment Form / Formulario Para el Pago Directo de Primas no Cubiertas

Short-Term Disability/Proof of Loss Form

Term Life / Accidental Loss of Life Claim Form

Vision Claim Form

If you need assistance completing any forms or have any questions, please call Flexible StaffCARE customer service at 1-844-262-6027. 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.

General Forms

Authorized Representative Form / Formulario de Representante Autorizado

Medical Claim Form (Indemnity Plan) / Formulario de Reclamo de Gastos Médicos (Plan de Indemnización)

Prescription Drug Claim Form / Formulario de Reclamo de Recetas Médicas

Limited Benefits Forms

Dental Claim Form

Missed Premium Direct Payment Form / Formulario Para el Pago Directo de Primas no Cubiertas

Short-Term Disability/Proof of Loss Form

Term Life / Accidental Loss of Life Claim Form

Vision Claim Form