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.

Tourer/Explorer/Mountaineer and

Pioneer Enriched Plans


ACE Medical Claim Form

Mountaineer RX Claim Form

Trail Blazer and Pioneer Elite Plans


Catlin Medical Claim Form

Express Scripts RX Claim Form

ISP Basic, Plus, Plus Sports and Preferred Plans

UHC Medical Claim Form

Optum Rx Claim Form