Submit a Claim

Before you start the online claims process, you will need:
  • Scanned receipts in pdf, jpg, jpeg, png or gif formats.
  • Scanned medical records in pdf, jpg, jpeg, png or gif formats.

NOTE: If you have received an email asking you to resubmit your claim, please login to My Account to resubmit it.

Online Claim

* Denotes A Required Field

Are you having problems with the forms? Can't properly view the site?
Check out our Technical Support FAQs for solutions to common issues, and contact information for our technical support team.