Form online 2026

1. Click ‘Get Form’ to open the Medical Expense Claim Form in our editor.
2. Begin by filling out the Plan Member Information section. Ensure you provide your full name, member ID, and contact details clearly.
3. In the Coordination of Benefits section, indicate if you have other insurance coverage. If yes, provide the necessary details about the other plan.
4. Complete the Claim Information section by detailing each expense type and attaching original receipts for verification.
5. If applicable, fill out the Vision Care Expenses section with specific information regarding your vision care claims.
6. Review all sections for completeness and accuracy before signing and dating the form at the end.
7. Submit your completed form electronically through our platform for efficient processing.

Start filling out your Medical Expense Claim Form online today for free!