Make A Claim

 Visit our forms page for fillable claim forms. Completed Claim Form Submissions must be accompanied by photo attachments of supporting documents including copies of original receipts, invoices, itemized bill, precertification  requests and any other reports relative to the type of claim being submitted. Please maintain original claims documents for future reference. Medical diagnoses can also be submitted directly to us from the physician’s office.

Kindly note that ALL claims payments are being done via online banking. The Online Banking Authorization Form can also be found on our website.

Submit Your Claims To: