Complete the appropriate sections of the claim form (page 2) 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I – Member Information. Enter the policyholder's name, policy number, mailing address, social security number, and date of birth. Ensure all fields are completed accurately.
3. Indicate whether the claim is for the policyholder or a dependent. If applicable, provide additional details such as email and phone preferences for claim processing notifications.
4. Proceed to Section II – Condition Details. Select the type of services for which you are filing a claim and provide specific information regarding any accidents or injuries, including dates and descriptions.
5. Review your entries carefully before submitting. Ensure that all required documents, such as itemized billing from your provider, are attached to avoid delays in processing.

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