CLAIM  FORMS
 **Links on this page were current as of 4/27/05**

Below are links to Claim Forms.  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.  Thank you.

 

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.  Call the office 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

  

 

   Aetna Medical Claim Form

Aetna Dental Claim Form

Aetna Vision Claim Form

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AFLAC - General Claim Forms

  

 

   AFLAC 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

  

 

   Ameritas Dental Claim Form

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

  

 

  

BCBS STD Claim Form

BCBS Prescription Drug Claim Form

BCBS Medical Claim Form

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Cigna - Forms for Dental, RX, STD and LTD

  

 

   Cigna Member Claim Form

Cigna Dental Claim Form

Cigna Prescription Drug Claim Form

Cigna STD Claim Form

Cigna 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.

  

 

   CNA/The Hartford STD Claim Form

CNA/The Hartford 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

GHP 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.

  

 

   Guardian Medical Claim Form

Guardian STD Claim Form

Guardian 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.

  

 

   Humana Dental Claim Form

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

Jefferson Pilot Dental Claim Form
 
Jefferson Pilot Life Claim Form
 
Jefferson Pilot LTD Claim Form
 
Jefferson Pilot 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.

  

 

   MetLife Dental Claim Form

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

 

  

Mutual of Omaha Medical Claim Form

Mutual of Omaha Dental Claim Form
administered thru United Concordia

Mutual of Omaha STD Claim Form

Mutual of Omaha LTD Claim Form

Mutual of Omaha 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

  

 

   Standard Ins. STD Claim Form

Standard Ins. LTD Claim Form

Standard Ins. 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

  

 

   UNUM 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 our client we hope you find the site useful and we would appreciate the opportunity to quote on your group or individual health/dental/disability program  .Please contact us via phone at 314-438-0222 or email.



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