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Submit a Claim Form

Access Claim Forms, Print Them Off and Submit Via Mail


Claim Form for Vision Care ServicesOpens PDF in new window

Complete this form to submit a claim for vision care expenses such as eye glasses and contact lenses. One form should be used per practitioner, per patient.

Send the completed form, along with itemized receipts that include the information below, to RBC Insurance.

  • Patient name
  • Copy of vision prescription
  • A breakdown of charges for lenses and frames
  • Date glasses were picked up

Note: There is no need to attach receipts if this form is completed in full by your provider.

Online Claims Submission
You can also check your eligibility for vision care benefits and submit vision care claims through the Online Group Benefit Solutions service for Plan Members.

Mailing Instructions
If mailing the form, please send to:
RBC Life Insurance Company
Attention: Vision Department
P.O. Box 1603
Windsor, Ontario
N9A 0B6


Claim Form for Custom Foot OrthoticsOpens PDF in new window

Complete this form to submit a claim for custom foot orthotic expenses such as shoes and inserts. Please note that the details requested on this form are mandatory.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7

Note: You can check your eligibility for this benefit online through the Online Group Benefit Solutions service for Plan Members.


Audio Claim FormOpens PDF in new window

Complete this form to submit a claim for audio expenses such as hearing aids. Please note that this form must be filled out for all pay plan member claims.

Send the completed form, along with itemized receipts that include the information below, to RBC Insurance.

  • Patient name
  • Services and dates
  • Audiologist name and address
  • Breakdown of charges (i.e. acquisition cost, fee, mold)

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7


Authorization Form for Custom BracesOpens PDF in new window

Complete this authorization form to request prior approval of claims for custom braces.

*Please note that the details requested on this form are mandatory and that a claim may be denied without prior authorization.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7

After reviewing your request, we will send you a response letter outlining your eligibility as soon as possible.

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.


Authorization Form for ProstheticOpens PDF in new window

Complete this authorization form to request prior approval of claims for prosthetics.

*Please note that the details requested on this form are mandatory and that a claim may be denied without prior authorization.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7

After reviewing your request, we will send you a response letter outlining your eligibility as soon as possible.

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.


Chronic Care / Alternate Level of Care ClaimOpens PDF in new window

This form must be completed by a Hospital Official and should be forwarded to our office (Attn: Hospital Claims Department) after the month for which the co-payment fee applies.

An assessment to determine eligibility for a reduced rate must be completed by a Hospital Official and copies of the results MUST be forwarded with the initial claim. The hospital will have a supply of the assessment forms as they are provided by the Ministry of Health directly to the hospital.

the completed form to:
RBC Life Insurance Company
P.O. Box 1603
Windsor, Ontario
N9A 0B6

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.


Hospitalization Claim FormOpens PDF in new window

Complete this form to submit a claim for a stay in a semi-private or private hospital room.

When completing the form, be sure to include the following information:

  • Patient name
  • Number of days in a semi-private/private accommodation
  • Rate charged per day
  • Admission and discharge dates

Mail the completed form, along with itemized receipts, to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1603
Windsor, Ontario
N9A 0B6


Dental Accident Report FormOpens PDF in new window

Send the complete form along with a predetermination or any incurred claims to:
RBC Life Insurance Company
P.O. BOX 1614 Windsor, Ontario N9A 0B9

Please note x-rays are required.


Dental Claim FormOpens PDF in new window

Complete this form to submit a claim for dental services.

We recommend that you also submit a pre-determination to us first before you receive any service valued over $300. This can help avoid surprises and out-of-pocket expenses in case a certain service isn’t covered.

Send the completed form, along with your original, fully paid receipt, to:
RBC Life Insurance Company
Attention: Dental Department
P.O. Box 1614
Windsor, Ontario
N9A 0B9

Be sure to keep a copy of your receipt for your records.

Online Claims Submission

Your dentist may also be able to submit claims to us on your behalf, and confirm if you owe any amounts due to deductibles and reimbursement levels. We will pay your dentist directly.

If you have the Deferred Payment option, you must pay your dentist in full and your dental office can then submit the claim to us electronically. Reimbursement will be sent directly to you.

Note: You can also check your eligibility for this benefit and access pre-populated forms through the Online Group Benefit Solutions service for Plan Members.


Health Spending Account (HSA) Claim Submission FormOpens PDF in new window

Complete this form to submit a claim for reimbursement under your Health Spending Account for eligible expenses that are not covered (or not covered in full) by your Health or Dental plan.

For a list of eligible expenses, please visit the Canada Revenue AgencyOpens in new window website.

Send the completed form, along with your original, fully paid receipt and an explanation of the benefit received, to the appropriate address listed on the form.

Be sure to keep a copy of your receipt for your records.


Claim Form for Medical DevicesOpens PDF in new window

Complete this form to submit a claim for a medical device. One form should be used per practitioner, per patient.

For custom-made foot orthotics or custom footwear, please use the Claim Form for Custom Foot OrthoticsOpens PDF in new window.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1613
Windsor, Ontario
N9A 0B8

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.


Authorization Form for Oxygen Equipment and SuppliesOpens PDF in new window

Complete this authorization form to request prior approval of claims for oxygen equipment and supplies.

*Please note that a claim may be denied without prior authorization.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1610
Windsor, Ontario
N9A 0B7

Note: This form is available, pre-filled with your personal details, within our Online Group Benefit Solutions service for Plan Members.


Claim Form for Related Health Professional ServicesOpens PDF in new window

Complete this form to submit a paramedical claim for services provided by a massage therapist, naturopath, chiropractor, etc.

When completing the form, be sure to include the following information:

  • Patient name
  • Type of service ie. Chiropractor, massage therapy, etc.
  • Individual date and nature of treatment
  • Charge for each service

Mail the completed form, along with itemized receipts, to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1603
Windsor, Ontario
N9A 0B6

Online Claims Submission

You may be able to submit this type of claim online. To find out more, sign in to the Online Group Benefit Solutions service for a list of eligible expenses.

Note: You can also check your eligibility for select practitioners and access pre-populated forms through the Online Group Benefit Solutions service for Plan Members.


Claim Form for In-Home Support Services of an RN RNA / Private Duty NursingOpens PDF in new window

Complete this form to submit a claim for in-home nursing services.

*Pre-approval is required for all nursing claims. Please call Customer Service at 1-855-264-2174 for details.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1601
Windsor, Ontario
N9A 0B4


Authorization Form for Post-Cataract Surgery and Prosthetic Eye WearOpens PDF in new window

Complete this authorization form to request prior approval of claims for post-cataract surgery and prosthetic eye wear.

*Please note that a claim may be denied without prior authorization.

Mail the completed form to:
RBC Life Insurance Company
P.O. Box 1603
Windsor, Ontario
N9A 0B6


General Claim SubmissionOpens PDF in new window

Complete this form for all general claims. Detailed instructions for eligible expenses are included on the form.

Send the completed form to the appropriate address listed on the form.

Online Claims Submission

Some claims can be submitted online. To find out more, sign in to the Online Group Benefit Solutions service for a full list of eligible expenses.

Note: You can also check your eligibility for some benefits and access pre-populated forms through the Online Group Benefit Solutions service for Plan Members.


Authorization Form for In-Home Support Services of an RN RNAOpens PDF in new window

Complete this authorization form to request prior approval of claims for in-home support services.

*Please note that the details requested on this form are mandatory and that a claim may be denied without prior authorization.

Mail the completed form to:
RBC Life Insurance Company
Attention: EHS Department
P.O. Box 1613
Windsor, Ontario
N9A 0B6

Fax: 1-855-612-3031


Group Life/Accidental Death Notice of ClaimOpens PDF in new window

When a beneficiary is making a life or accidental death claim on behalf of a deceased and insured individual, the beneficiary, the deceased’s employer and the deceased’s physician must complete the appropriate sections of this form.

Please follow these steps to complete and submit this form:

Beneficiary Instructions

  1. Complete the claimant section of the form.
  2. Return the form to the insured’s employer for completion.

Instructions for the Employer of the Insured

  1. Complete the employer section and sends all forms, along with original enrolment form and any change of beneficiary form(s) to RBC Insurance.

Mail the completed form(s) to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Loss of Use / Dismemberment Notice of ClaimOpens PDF in new window

When an insured individual is making a claim for dismemberment, loss of use, loss of sight, etc., he or she will need to complete the appropriate sections of this form.

Note: The form also includes sections that must be completed by the insured individual’s employer and physician.

Please follow these steps to complete and submit this form:

Employee Instructions:

  • Complete the Claimant’s/Employee’s Statement section within this form and return to your employer.
  • Complete and sign the Authorization section on the Attending Physician’s Statement, and send this form to your treating physician for completion. The form can be returned directly to RBC Insurance once completed.

Employer Instructions:

Complete the following sections within this form:

  • Employer’s Statement
  • Claimant’s/Employee’s Statement
  • The original enrolment form

Mail the completed form to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Notice of Critical Illness FormOpens PDF in new window

Complete this form when submitting a claim for critical illness insurance benefits. The form also includes a section to make a claim for return of premium upon death if this is covered under the policy.

Please follow these steps to complete and submit this form:

Critical Illness Claim:

  1. Complete all sections within this form
  2. Mail completed form to RBC Insurance

Return of Premium on Death:

  1. Complete sections A, E and F only
  2. Attach a Funeral Director’s Statement
  3. Mail completed form and Funeral Director’s Statement to RBC Insurance.

Mail the completed form to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Attending Physician Supplementary StatementOpens PDF in new window

When submitting a disability or critical illness claim, your physician must complete this supplementary statement.

Send the completed form to the address listed on the form.


When submitting a disability claim, you must have your attending physician complete one of the following forms.

If you are not sure which form is appropriate, use the General Statement:

Mail the completed form to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


AWI/STD/ASO/ - STD Disability Claim FormOpens PDF in new window

Complete this new claim application package to make a claim for short term disability or accident weekly income benefits.

Note: The application package also includes sections that must be completed by your employer and physician.

Mail the completed claim package to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Claimant Supplementary StatementOpens PDF in new window

Complete this form to make a claim for disability benefits.

Mail the completed form to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Group Disability Claim Form - Employee Statement

Complete this form to make a claim for disability benefits.

Mail the completed form to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Group Disability Claim Form - Employer StatementOpens PDF in new window

Your employer must complete this form if you are making a disability claim.

Mail the completed form to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Spouse Disability Notice of ClaimOpens PDF in new window

When submitting a spousal disability claim, your spouse will need to complete this statement.

Note: The form also includes sections that must be completed by your employer and the treating physician.

Please follow these steps to complete and submit this form:

Claimant Instructions:

  1. Ensure that the Employer’s Statement is completed.
  2. Complete the Spouse’s Statement and return along with the Employer’s Statement to RBC Insurance.
  3. Send the Attending Physician’s Statement to the treating physician and have this for returned to RBC Insurance.

Employer Instructions:

  1. Complete the Employer’s Statement and attach Proof of Enrolment.
  2. Send this form along with the Spouse’s Statement and the Attending Physician’s Statement to the claimant.

Mail the completed form(s) to:
RBC Life Insurance Company, Life & Health Claims Department
P.O.Box 4435, Station A
Toronto, Ontario
M5W 5Y8

Or Fax to:
1-800-714-8861


Travel Emergency Medical

Select the form required for the type of claim you are making:

Please note: Depending on the claim, we may request more information.


Trip Cancellation

If you need to cancel your trip you will need to complete the following steps to submit your claim:

  • Call your travel agent, airline, tour company or the carrier immediately to cancel your trip (no later than one business day after the cause of cancellation).

  • Notify us by calling one of the numbers below:

    • 1-855-603-5571 (toll-free from Canada or U.S.)
    • (905) 608-8251 (collect call from anywhere)
  • Complete and sign the Trip Cancellation Claim and Authorization FormOpens PDF in new window.

    Mail the form, along with all applicable documents outlined below, to:

    RBC Insurance Company of Canada
    P.O. Box 97, Station A
    Mississauga, Ontario L5A 2Y9

  • If the cancellation is due to an injury or sickness of yourself, an immediate family member or your travelling companion, you must have a Medical CertificateOpens in new window fully completed by the treating physician. The physician who fills out the certificate must be the same one who treated the sick or injured person on the date of the cause of cancellation.

  • If the medical condition is for yourself or your spouse, you will also need to provide your family physician's clinical notes from the 90 days prior to your insurance application date up to the present date.

  • Submit an itemized copy of your invoice, providing a breakdown of the cost of your trip including airfare, hotel, taxes, service fees, and anything else. You'll need to provide proof of paymentOpens in new window for each item.

  • Attach original unused airline ticket(s) and any other original travel documents. If you received a refund from your travel agent or travel supplier, you'll need to provide a copy of the statement or refund.

  • If cancelling for non-medical reasons, you'll need to provide substantiated evidence. This could be a copy of subpoena for court/jury duty, a letter from your employer, a report from your airline/cruise, or a death certificate.


Trip Interruption

If you had to return home early from your trip due to a sickness, injury or another unexpected covered situation that occurred during your trip, follow these steps to submit a Trip Interruption Insurance claim:

  • Complete and sign the Trip Interruption Claim and Authorization FormOpens PDF in new window.

    Mail the form, along with all applicable documents outlined below, to:

    RBC Insurance Company of Canada
    P.O. Box 97, Station A
    Mississauga, Ontario L5A 2Y9

  • If the interruption is due to an injury or sickness of yourself, an immediate family member or your travelling companion, you must have a Medical Certificate Opens in new window fully completed by the treating physician at your travel destination. The physician who fills out the form must be the same one who treated the sick or injured person at your travel destination.

  • Submit an itemized copy of your invoice, providing a breakdown of the cost of your trip including airfare, hotel, taxes, service fees, and anything else. You'll need to provide proof of paymentOpens in new window for each item.

  • Attach original unused airline ticket(s) along with the new return tickets you purchased. If you paid a change fee, you'll need to include the original receipts for this cost.

  • If the interruption is due to non-medical reasons, you'll need to provide substantiated evidence. This could be a copy of subpoena for court/jury duty, a letter from your employer, a report from your airline/cruise, or a death certificate.

  • If you incurred additional expenses as a result of one of the insured risks, you'll need to submit original receipts for all additional costs such as hotel accommodations, meals, essential telephone calls, or taxi fares.


Confirmation of Coverage LetterOpens PDF in new window

Prior to travelling, review your Employee Benefits Booklet to understand what your benefits cover. Take this letter along with your RBC Insurance ID card with you when you travel to countries requiring proof of coverage. Please call 1-855-264-2174 if you require a personalized detailed letter.

Note: Forms are provided in Adobe PDF format. A recent version of Adobe ReaderOpens in new window or Adobe Acrobat may be required to open, read and print a form on your system.

Submit Health or Dental Claim Forms Digitally

You can also submit all your health and dental claims through the My Benefits app or through your Online Group Benefit Solutions account.

Sign InOpens in new window How to Download the AppOpens in new window

We're Here When You Need Us.

Whether you need to make a claim or have a question about our services, we can help.

How to Make a Claim

Please review your Employee Benefits Booklet to understand what your benefits cover and complete the appropriate steps below to file your claim:

Depending on the type of claim, you may be able to file online, from your smartphone, or have your service provider file electronically for you (check with your provider).

Health and Dental Claim Tips:

Before making a claim, you can view your eligibility or submit a “mock” claim to confirm your coverage, how much will be paid and any limits or conditions under your plan. There are two ways to do this:

If you or your dependents are covered under more than one benefit plan (for example, your spouse's plan), you can claim up to 100% of an eligible expense by coordinating your benefits under both plans.

How to coordinate your benefits:

  • Submit your claim under your plan first, and send any remaining balance to your spouse’s plan.
  • Your spouse's claims should go to his or her plan first, with any remaining balance sent to your plan.
  • Dependent children are covered first by the plan of the parent whose birthday falls earlier in the year. So, if your birthday falls in January and your spouse's birthday is in March, you should submit your child’s claims to your plan first.
  • You will receive an Explanation of Benefits (EOB) statement from the first insurance company you file with showing how much of the claim has been covered. Submit the EOB statement, along with copies of your expense receipts, to the second insurance company in order to claim any remaining eligible balance.

Not sure if a service is covered? We recommend that you get pre-authorization from us first before you receive any service valued over $300. This can help avoid surprises and out-of-pocket expenses in case a certain service isn’t covered.

Some health and dental providers can submit claims to us on your behalf, and let you know if you owe any amounts due to deductibles and reimbursement levels. Check with your provider to see if this option is available.

Once we receive your completed claim form, we will acknowledge our receipt of it within one business day. We will schedule a telephone call with the assigned disability claims specialist, and make a decision to approve—or ask for more information—within 10 business days. You will be provided with a status of your claim every 30 days until a decision is made.

We recommend submitting your completed claims forms (client + authorization, employer and physician statements) 8 weeks prior to the end of the elimination period to ensure a timely decision.

  • Complete the sections on the form that apply to you, and have your doctor complete the ‘attending physician’s’ section of the form
  • Be sure your doctor includes a specific diagnosis and indicates how your condition affects your ability to do your job
  • Your doctor will also need to list all treatments you are receiving, including surgery, medications, physiotherapy, etc.
  • Submit the form to your benefit administrator or human resources department so they can complete their section to confirm your absence

Make sure your claim form is accurate and completed in full, signed, and submitted with the paid receipt enclosed. We cannot accept photocopies and faxed receipts.

Always keep your personal information up-to-date (bank account, address, etc.) You can make updates easily by signing inOpens in new window to our Online Group Benefit Solutions service.

Ensure your Explanation of Benefits claim statements are correct and double-check receipts to be sure you received what is being charged to your plan. Providing false claim documents or exaggerating services constitutes fraud. If you realize you have made a mistake after submitting a claim, let us know right away so we can help correct the situation.

Call:

  • 1-855-603-5571 (in Canada or USA) or
  • 1-905-608-8251 (collect from anywhere in the world).

Our toll-free call centre is available 24 hours a day, 365 days a year worldwide, and can help to ensure you get the care you need without incurring unnecessary out-of-pocket expenses.

Your ID card also contains contact information in the event of an emergency. Prior to seeking medical treatment, it is important to call the number listed on your ID card as soon as possible.

Travel Tips:

Prior to travelling, review your Employee Benefits Booklet to understand what your benefits cover.

  • If you have a medical emergency while on your trip, one toll-free phone call puts you in touch with a multilingual coordinator who can help you—24 hours a day, seven days a week.
  • Call 1-855-603-5571 (in Canada or the U.S.) or 1-905-608-8251 (collect from anywhere in the world)
  • If the medical emergency prevents you from calling before receiving treatment, we ask that you (or someone else on your behalf) call us at the earliest opportunity.

Download the Path app for free from the Apple StoreOpens in new window or Google PlayOpens in new window. With this app, you can:

  • Search your location to find a medical facility for emergency assistance
  • Call or email Assured Assistance directly for emergency medical assistance
  • Access worldwide assistance numbers
  • Contact local emergency services
  • Access up-to-date travel advisories

Need entertainment planning or assistance during your trip? Take advantage of our complimentary concierge services. Here are few examples of what concierge services can help you with:

  • Travel information services: currency exchange rates, ATM locations, ground transportation, consulate and embassy locations, hotel reservations, baggage tracing, international driver's license information, customs information, details on country-to-country calling, and more
  • Entertainment planning: restaurant and golf course locations/reservations, spa reservations, tickets for events, yacht and fishing charter reservations, and more
  • Personal services: email/phone messaging to family and friends, floral services, legal/bail assistance, and more
  • Call 1-855-603-5571 toll free in Canada or the U.S. or 905-608-8251 collect from anywhere in the world.

To make a claim for short term disability, the AWI/STD/ATP – STD Disability Claim FormOpens PDF in new window must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed within the form:

  • You (the employee) complete: Client’s Statement
  • Your employer completes: Employer/Carrier Statement
  • Your doctor completes: Attending Physician’s Statement – Short Term Disability Claim.

To help avoid delays, all forms should be completed in full and submitted to intake@rbc.com as soon as possible.

Dealing with a disability can be stressful. We’re here to help support you and make things as easy as possible. Review the following for an overview of what to expect when making a disability claim.

  • Make sure all required claim forms are completed and submitted as early as possible—ideally at least 8 weeks prior to the end of the elimination period.
  • While on claim, focus on your recovery and follow any treatment program that your physician recommends.
  • Keep in touch with your disability claims specialist and your employer.
  • See the below for additional guidance on what to expect throughout the claims process.

To make a claim for long term disability or a stand-alone life waiver of premium, the Group Disability Claim Form must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed:

You may select which form to have completed based on your condition. Otherwise, the General FormOpens PDF in new window may be used.

To help avoid delays, all forms should be completed at least 8 weeks before the end of the elimination period (i.e. the waiting period before benefits are paid).

Dealing with a disability can be stressful. We’re here to help support you and make things as easy as possible. Review the following for an overview of what to expect when making a disability claim.

  • Make sure all required claim forms are completed and submitted as early as possible—ideally at least 8 weeks prior to the end of the elimination period.
  • While on claim, focus on your recovery and follow any treatment program that your physician recommends.
  • Keep in touch with your disability claims specialist and your employer.
  • See the below for additional guidance on what to expect throughout the claims process.

To make a life insurance or accidental death claim, the Group Life/Accidental Death Notice of ClaimOpens PDF in new window must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed within the form:

  • The employee’s beneficiary completes: Client’s Statement
  • The employer completes: Employer’s Statement
  • The employee’s doctor completes: Physician’s Statement (should be submitted for all accidental death claims and for all life claims in any amount)

To make a loss of use or dismemberment claim, the Loss of Use/Dismemberment Notice of ClaimOpens PDF in new window must be completed in full and emailed to intake@rbc.com.

Note that there are 3 statements to be completed within the form:

  • You (the employee) complete: Client’s/Employee’s Statement
  • Your employer completes: Employer’s Statement
  • Your doctor completes: Attending Physician’s Statement

Check a Claim’s Status or Get Help with a Claim

To check your claim’s status or get help with a form:

  • Call 1-855-264-2174, Monday to Friday: 8am to 8pm, ET

Or email us:

Understand prescription drug costs and how to save money when making a claim.

Plan Member FAQs

Don’t see your question? Please contact your Plan Administrator or call us at 1-855-264-2174.

Contact Us for Assistance—We Can Help.

Claims, Services, or General Questions

  • Toll-Free 1-855-264-2174 Mon-Fri: 8am 8pm, ET
  • Email us for Life, AD&D, Disability & Critical Illness
  • Email us for Health & Dental

Technical Assistance and Registration

  • Call us at 1-855-264-2173, Monday to Friday: 8am to 8pm, ET