TieCare

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CLAIM FORMS

When available, the fastest and simplest way to submit your claim is filing online with the Online Form.

General Forms (English)

Form Name

Online Form

Paper Size

8.5x11

Appeals Form

Application Form for Individual Coverage

Catlin Claim Form

N/A

Dental Claim Form

Direct Billing Request Form

Disability Claim Form

Electronic Deposit and Wire Transfer Form

Group Medical Health Statement

FAQ (Frequently Asked Questions)

Global 360 Latin America Application Form for Individual Medical Coverage

Medical, Wellness and Vision Claim Form

Life Claim Form

Life Insurance Beneficiary Form

Maternity Questionnaire

Medical Accident Questionnaire

Medical Release Form

Personal Representative Appointment

Preauthorization Form

Transition Of Care Application Form

General Forms (Chinese)

Form Name

Online Form

Paper Size

8.5x11

Appeals Form

Claims Form

Direct-Billing Provider List in Greater China

Group MHS - General Forms (Taiping)

How to File a Claim - General Information on Claims (Taiping)

Instruction of Using Smart Cards - Group (Taiping)

Pre-Authorization Flow Chart (Taiping)

Pre-Authorization Form

General Forms (Portuguese)

Form Name

Online Form

Paper Size

8.5x11

Medical, Wellness and Vision Claim Form

Travel Claim Form

General Forms (Spanish)

Form Name

Online Form

Paper Size

8.5x11

Disability Claim Form

General Information On Claims

Global 360 Latin America Application Form for Individual Medical Coverage

Medical, Wellness and Vision Claim Form

Life Claim Form

Life Insurance Beneficiary Form

Travel Claim Form

General Forms (Japanese)

Form Name

Online Form

Paper Size

8.5x11

Claim Form - Provider's Verification

Preauthorization Form

General Forms (French)

Form Name

Online Form

Paper Size

8.5x11

Dental Claim Form

Student Insurance Forms

Form Name

Online Form

Paper Size

8.5x11

Student Insurance Appeal Form

Student Medical Claim Form

Student Insurance Pregnancy Verification Form

Student Insurance Medical Accident Questionnaire

Safe Travels Forms

Form Name

Online Form

Paper Size

8.5x11

Safe Travels Medical Claim Form

Safe Travels Trip Claim Form

Travel Forms

Form Name

Online Form

Paper Size

8.5x11

Group Travel Application Form

Travel Claim Form

Travel Claim Form (Spanish)

Travel Claim Form (Portuguese)

Travel Claim Form (German)

24/7 Customer Service
USA/Canada Toll-free: +1.866.914.5333
Worldwide Collect: +1.905.669.4920
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