Resources & Forms

Submitting a Claim

Need to submit a claim? You'll find the most frequently used forms below. Follow the directions on each form to make sure that your benefits are applied correctly.

If you can't find what you need, or need help submitting a claim, please contact Member Services using the phone number on the back of your member ID card.

	Medical Claim Form (In-Area) (PDF)
	Medical Claim Form (Out-of-Area) (PDF)
	International Claim Form (PDF)
	Continuity of Care - Members in a Maryland Based Plan (PDF)
	Continuity of Care - Provider Not in Network (PDF)