Claims & Requests

Call us for help with claims and requests.

Coverage cannot be bound or altered online. Complete the form below to have a service representative contact you to finalize your request.

Type of Inquiry *

First and Last Name *

Email Address *

State of Residence (2-letter abbreviation) *

Phone *

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Employer Name

Member Number

Comments *

Please note: Claims and change requests cannot be completed online. A service representative will need to contact you to finalize your request.