member forms and policy documents

find claims forms and instructions, limitations and exclusions, and explore state notices.

Member Forms

To file a claim, select the claim form that matches your policy. Send your claim by mail or fax to the mailing address or fax number listed on your claim form.

Disability Claims
Hospitalization due to Sickness Claims
Accident Fixed-Benefit Claims
Loss of Life Beneficiary Form
Change of Beneficiary Form
Vision Claim Form
Hearing
Limited Medical Insurance Claims
Accident Medical Expense Claims
Dental Claims
Critical Illness Claims
HIPAA Authorization
EFT Change Authorization Form
Prescription Claims Form

State Notices

Texas Dental PPO Notice
MI Technical Notice
MI Electronic Delivery Notice
MI Non-Opioid Directive Form

member forms and policy documents

Member Forms

State Notices

NatGen Access Exclusions by State

Short Term Medical Limitations & Exclusions by State

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