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Claims Forms

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 2008 Pharmacy Claim Form for PPO and Indemnity Members

 BlueChoice Member Health Expense Report
 BlueChoice Pharmacy Expense Form

 UHC Health Claim Transmittal Form  - Updated 2/18/08
Use this form for PPO, Indemnity and High Deductible Plan members for dates of services January 1, 2006 forward.

 Lumenos Customer Medical Claim Form
 Lumenos MedCo Pharmacy Expense Form

Kaiser Permanente
No claim form required.  Submit itemized bill containing the member name and ID number to:  Kaiser Permanente, Claims, P.O. Box 190849, Atlanta, GA 31119-0849