United HealthCare Medical Claim
This form should be completed when you have paid for services and need to request reimbursement. When seeking care in the U.S., providers will generally submit your claims directly to UnitedHealthcare eliminating the need for you to do so. Requests for reimbursement should be faxed or mailed to the address(es) shown on the form.

  United HealthCare International Claim Form
This form should be completed if you have had emergency medical care rendered while travelling outside the U.S. and you are covered under one of the plan options administered by United Healthcare

  United Healthcare Vision Claim Form for Non-Network Provider
This form needs to be completed only if you use a provider who does not participate in the UnitedHealthcare Vision network. Network providers will file the claim for you.

  CIGNA Dental Claim
This form should be completed when you have paid for services and need to request reimbursement. When seeking care in the US, providers will generally submit your claims directly to UnitedHealthcare eliminating the need for you to do so. Requests for reimbursement should be faxed or mailed to the address(es) shown on the form.

  Flexible Spending Account Claim Form
Use this form if you are currently enrolled in either the Dependent Day Care or Health Care FSA to submit claims for reimbursement of eligible expenses. Please be sure to attach the necessary documentation.  

  Prescription Drug Reimbursement Form
This form should be completed if you need to submit expenses for medications you purchased at a non-network retail pharmacy.