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
Medical Claim Form (Indemnity Plan) / Formulario de Reclamo de Gastos Médicos (Plan de Indemnización)
Medical Claim Form (MEC/ESC 5500 Plans) / Formulario de Reclamo de Gastos Médicos (Planes de MEC/ESC 5500)
Prescription Drug Claim Form (Use this form if Rx group ECPAI is on your ID card.) / Formulario de Reclamo de Recetas Médicas (Utilice este formulario si el grupo Rx ECPAI está en su tarjeta de identificación.)
Prescription Drug Claim Form (Use this form if Rx group ECFDRX is on your ID card.)
Prescription Drug Reimbursement Claim Form (MEC)
Wellness and Preventive Reimbursement Claim Form
Dental Claim Form
EyeMed Out-of-Network Claim Form
Indemnity Plan Missed Premium Direct Payment Form
MEC Plan Missed Contribution Direct Payment Form
Short-Term Disability/Proof of Loss Form
Term Life / Accidental Loss of Life Claim Form
HIPAA-all groups