Claim Forms

If you ever need to make a claim, you can find the claim forms for each insurer here. Find out which insurer your plan uses by checking your ID card.

ISP Trail Blazer and Pioneer Elite Plans with member id # beginning with the letter "S"


Medical Claim Form

Trail Blazer and Pioneer Elite Plans for Member ID # that begins with 4 letters


XL Catlin Medical Claim Form

Express Scripts RX Claim Form


ISP Essential, ISP Basic, ISP Plus and ISP Elite Plans

UHC Medical Claim Form

Optum Rx Claim Form

Tourer/Explorer and Mountaineer Plans


ACE Medical Claim Form

Mountaineer RX Claim Form

IMG Patriot, Patriot Exchange and Student Health Advantage Plans

Medical Claim Form