Option B Claim Form - SDC-League Pension and Health Funds - sdcweb 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the designated fields, including your name, address, and member ID number. This ensures that your claim is accurately processed.
3. Next, provide details about your primary insurance carrier. Fill in the policy group number and include the insurance carrier's address and contact numbers for verification purposes.
4. List all service providers along with their contact information. Make sure to include the date of service for each entry to maintain clarity.
5. Select the appropriate category for each service from the provided options (e.g., Dental, Optical). Enter the amount requested for reimbursement next to each category.
6. Sign and date the form at the bottom, authorizing the release of necessary records. Attach proof of payment and any relevant documentation from your primary insurance carrier.

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