If you need assistance completing any forms or have any questions, please call HospitalityCARE customer service at 1-888-583-3057. 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)

Medical Claim Form (MEC Plans) / Formulario de Reclamo de Gastos Médicos (Planes de MEC)

Prescription Drug Claim Form (Use this form if RxGRP: DISCOUNT is on your ID card.) / Formulario de Reclamo de Recetas Médicas (Utilice este formulario si RxGRP: DISCOUNT está en su tarjeta de identificación.)

Prescription Drug Claim Form (Use this form if RxGRP: BXPAI is on your ID card.)

Prescription Drug Reimbursement Claim Form (MEC)

Wellness and Preventive Reimbursement Claim Form

Limited Benefits Forms

Accidental Dismemberment Claim Form

Accidental Dismemberment Claim Form-Attending Physician's Statement

Accidental Dismemberment Claim Form

Accidental Loss of Limb or Sight Claim Form-Attending Physician's Statement

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