Announcement Announcement

The website is now enhanced with new standards that increase the level of security.

If your last login attempt was prior to 11/01/2012, you will need to re-register your account. Click "Enroll" to complete the registration process.

If you have logged in since 11/01/2012, you will need to reset your password before you can access your account. Click the "Forgot UserID or Password" link below for your password to be reset. Once you have reset your password, this step will not be required during future logins.

Notification Notification

UPGRADE:  We are going to be upgrading our site.
The following browsers will no longer work - IE 9 and IE 10.  Please upgrade to one of the following browsers - IE 11, Chrome, Firefox, or Edge.

California Fires California Fires

We extend our concern to those whose lives have been impacted by recent natural disasters, including the California wildfires. To those who are currently in the affected areas, please stay safe. We realize this could be a difficult time and we would like to work with affected policy owners to help answer any questions or concerns they may have about their insurance coverage. Please contact us Monday through Friday at (800) 525-7662 between 8 a.m. and 6 p.m. EST.

Nested Applications

Claim Forms

To download a form, select the state of coverage and the appropriate form, from options below. All forms are in
Adobe Acrobat PDF format.

 

image You can download forms in pdf format for printing.You will need Adobe Acrobat Reader to download and view a pdf file.If you do not have Adobe Acrobat Reader click here to download a free copy.

 

Welcome to the Online Service Center for Providers

We understand the importance of serving your insurance needs when it matters most. That's why we share access 24/7 to claims forms, policy information and policy change forms, contact information, and much more! 

We have partnered with Zelis to offer Electronic Payment (EFT) and Electronic Remittance & Advice (ERA) for Medicare Supplement products. As an enrolled healthcare provider, you can access processed claim information, receive electronic payments, and manage claims payments.

Enroll today.