Get How To File A Claim 1. Please Complete All Portions Of This Form ...

Filing a claim can be a straightforward process when you know what to expect. This guide provides step-by-step instructions on how to properly complete the HOW TO FILE A CLAIM form online, ensuring you provide all necessary information to facilitate your claim.

Follow the steps to successfully complete your claim form online.

1. Press the ‘Get Form’ button to download the claim form and open it in your preferred document editor.
2. Fill in all portions of the form carefully, as incomplete submissions cannot be processed. Ensure that each section is filled out accurately.
3. Review the 'Benefits' section of your Certificate of Coverage to determine your eligibility for specific benefits.
4. Provide your personal information. This includes your name, Social Security number, and address. Ensure the details match those on your official documents.
5. If the claimant is different from the employee or retiree, complete the claimant’s information section, including Social Security number, relationship to the employee, and current address.
6. Indicate where the claimant is currently residing from the provided options, such as a nursing care facility or assisted living.
7. List the primary diagnosis and any other contributing conditions that necessitate assistance.
8. Specify the type of assistance needed and when the need for assistance began.
9. Include information on past hospitalizations or facility confinements in the past year, detailing names, admission dates, and reasons for admission.
10. List the physicians involved in the claimant’s care, including their specialties, addresses, and contact numbers.
11. If applicable, note whether the claimant is receiving any home health services or therapies, providing details of the service providers.
12. Complete the section for the person filling out the form, including their relationship to the claimant and contact details.
13. If necessary, authorize a primary contact to assist with the claim and complete the required signature section.
14. Once all sections are completed, save your changes, download the finalized document, and prepare to submit it.
15. Submit the completed form along with any required documents to the indicated address for processing.

Get started today by filling out your claim form online.