How to File an Employee Claim

Filing a claim is easy. Submit a claim online through our member service center or download a copy below.

Accident and Health Screening Claim Form

Accident Claim Form

Claimant Authorization for Claims Payment via Electronic Funds Transfer

Travel and Lodging Claim Form

Cancer Wellness Claim Form  

Cancer Claim Form

Claimant Authorization for Claims Payment via Electronic Funds Transfer

Travel and Lodging Claim Form

Critical Illness 1301 Cancer Claim Form

Critical Illness 1301 Cancer Wellness Claim Form

Critical Illness 1805 Claim Form

Critical Illness 1805 Wellness Claim Form

*Please review your certificate of coverage to determine if you have the CI-1301 or CI-1805 form number (easily found on the bottom left of the certificate)

Claimant Authorization for Claims Payment via Electronic Funds Transfer

Travel and Lodging Claim Form

Claimant Authorization for Claims Payment via Electronic Funds Transfer

MedMutual Protect GAP Claim

Signature GAP Claim

Claimant Authorization for Claims Payment via Electronic Funds Transfer

In-Hospital Indemnity Benefit Claim Form

Short-term Disability Claim Form

Claimant Authorization for Claims Payment via Electronic Funds Transfer

Death Benefit Claim Form

Page last updated on 6/25/2026