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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
A4
Appeals Form
Application Form for Individual Coverage
 
Attending Physician Statement
 
Catlin Claim Form
 
N/A
Dental Claim Form
Diabetic Medical Questionnaire
 
Direct Billing Request Form
 
Disability Claim Form With Instructions
 
Electronic Deposit and Wire Transfer Form
Enrollment Form (Group)
 
FAQ (Frequently Asked Questions)
 
Global 360 Latin America Application Form for Individual Medical Coverage
 
Health, Wellness and Vision Claim Form
Hypertension Medical Questionnaire
 
Life Claim Form With Instructions
 
Life Insurance Beneficiary Form
 
Maternity Questionnaire
Medical Accident Questionnaire
Medical Release Form
Personal Representative Appointment
Preauthorization Form
Skin Lesion Removal Questionnaire
 
Transition Of Care Application Form
 

General Forms (Chinese)

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Appeals Form
 
Claims Form
 
Direct-Billing Provider List in Greater China
 
Group MHS (General Forms)
 
How to File a Claim (General Information on Claims)
 
Instruction of Using Smart Cards (Group)
 
Pre-Authorization Flow Chart
 
Pre-Authorization Forms
 

General Forms (Portuguese)

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Health, Wellness and Vision Claim Form
Travel Claim Form

General Forms (Spanish)

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Disability Claim Form With Instructions
 
General Information On Claims
 
Global 360 Latin America Application Form for Individual Medical Coverage
 
Health, Wellness and Vision Claim Form
Life Claim Form With Instructions
 
Life Insurance Beneficiary Form
 
Skin Lesion Removal Questionnaire
 
Travel Claim Form

General Forms (Japanese)

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Claim Form - Provider's Verification
 
Preauthorization Form
 

Student Insurance Forms

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Student Insurance Appeal Form
 
Student Insurance Claim Form
 
Student Insurance Pregnancy Verification Form
 
Student Insurance Medical Accident Questionnaire
 

Safe Travels Forms

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Safe Travels Medical Claim Form
 
Safe Travels Trip Claim Form
 

Travel Forms

Form Name
Online Form
Paper Size
 
 
8.5x11
A4
Group Travel Application Form
 
Travel Claim Form
Travel Claim Form (Spanish)
Travel Claim Form (Portuguese)
Travel Claim Form (German)
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