Online Claim Forms


Need Help Viewing Forms?

  1. Click the form you want to download. It will either open in your web browser or Acrobat Reader.
  2. Go to the File menu and choose Save (or Save Page As).
  3. Choose a location to save the form.

NOTE: If the form does not open in your web browser or Acrobat Reader, you need to install Acrobat Reader from the Adobe website.

If you need help with any online claim form, call Medipac Claims at: 1-888-311-4761

If you require emergency assistance, call Medipac Assist at: 1-800-813-9374