Annual claim form 2026

1. Click ‘Get Form’ to open the annual claim form in the editor.
2. Begin by filling out the 'Participant Information' section. Enter your name and Social Security number accurately.
3. Proceed to the 'Dependent Information' section. Provide your dependent's name, Social Security number, address, date of birth, and employment status.
4. If employed, include your employer's details such as name, address, employment start date, and phone number.
5. Complete the 'Dependent Spouse’s Information' if applicable. Fill in their details similarly to how you filled out your own information.
6. In the 'Other Insurance Information' section, indicate if you or your spouse are covered under any other insurance plans. If yes, provide all requested details.
7. Review all entered information for accuracy before signing and dating the form at the bottom.

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