CLAIM  FORMS
 **Page was last updated on 4/27/05**

Here you will find shortcuts to Claim Forms from many carriers.  If you can’t find something please call or email the office.  If you find a dead link let us know as some carriers tend to change their pages.   Some carriers don't publish direct links to their forms. If you don't see what you are looking for in the table check the list at the bottom of the page.  If you are our client you may also call us at 314-438-0222 if you can’t print one or would like one mailed directly to you. Most of the forms are published with Adobe Acrobat.   If you don't have Adobe Acrobat you can get the free reader.

 

Aetna BCBS-MO Guardian Mercy Health Plans Standard Insurance
AFLAC Cigna Hartford Life MetLife United American
Allied National CNA/The Hartford Humana Mutual of Omaha United HealthCare
American Medical Security GHP Jefferson Pilot Pacific Life UNUM
Ameritas Golden Rule Kansas City Life Reliance  

Take a short survey about your employers insurance and we will send you a free calendar.

Aetna - You even have a personal online library of your claim explanation of benefits available in a printer-friendly format. Aetna Complete Forms Library

   Medical Claim Form

Dental Claim Form

Vision Claim Form

 

  

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AFLAC - General Claim Forms

   Claim Forms

 

  

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Allied National -  Claim form for Dental only

   Horizons Dental Claim Form

 

  

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American Medical Security  - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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Ameritas - Claim form for Dental only

   Dental Claim Form

 

  

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BCBS-MO -  Check on your member's eligibility, obtain forms, contact Customer Service.

  

STD Claim Form

Prescription Drug Claim Form

Medical Claim Form

 

  

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Cigna - Forms for Dental, RX, STD and LTD

   Member Claim Form

Dental Claim Form

Prescription Drug Claim Form

STD Claim Form

LTD Claim Form

 

  

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CNA/The Hartford - On January 1, 2004 The Hartford acquired CNA's group life and accident, and short-term and long-term disability business, including CNA Group Life Assurance Company.

   STD Claim Form

LTD Claim Form

 

  

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GHP -  In support of HIPAA and its goal of administrative simplification, Group Health Plan & Coventry Health Care of St. Louis encourages physicians and medical providers to submit claims electronically.

   CareMark c/o GHP Prescription Reimbursement Form

Medical Claim Form

 

  

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Golden Rule - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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Guardian - No Dental links are available as of 4/27/05.  Email our office for their current forms.

   Medical Claim Form

STD Claim Form

LTD Claim Form

 

  

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Hartford Life - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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Humana - No links are available as of 4/27/05.  Email our office for their current forms.

   Dental Claim Form

 

  

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Jefferson Pilot - Forms for Dental, Life, LTD & STD  

Dental Claim Form
 
Life Claim Form
 
Pilot LTD Claim Form
 
STD Claim Form

 

  

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Kansas City Life - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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Mercy Health Plans - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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MetLife - No links are available as of 4/27/05.  Email our office for their current forms.

   Dental Claim Form

 

  

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Mutual of Omaha - Forms for Health, Dental, Vision, Disability  

Medical Claim Form

Dental Claim Form
administered thru United Concordia

STD Claim Form

LTD Claim Form

Vision Claim Form

Pacific Life - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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Reliance - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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Standard Insurance - Forms for Life & Disability

   STD Claim Form

LTD Claim Form

Life Ins. Claim Form

 

  

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United American - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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United HealthCare (UHC) - No links are available as of 4/27/05.  Email our office for their current forms.

    

 

  

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UNUM - Use this form for both STD and LTD claims

   Disability Claim Form

 

  

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This site was made for our clients, mainly in the St. Louis Metro area (MO & IL).  If you are not a current group insurance or individual insurance client we hope you find the site useful and we would appreciate the opportunity to quote on your group or individual health, dental, disability, or life program.