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This website is designed for members whose benefits are administered by MedCost Benefit Services.
Claims forms are here for your members. If you have questions, please call our Customer Service Contact Center at 1-800-795-1023.
If you received care or a bill from an out-of-network provider, use these forms to submit a claim for reimbursement or to request coverage.
Members can use the following forms to give MedCost permission to share information about themselves (or a dependent) with another person or organization.
Reimbursement forms related to your flexible spending account (FSA).
Members use this form for short-term disability claims.
Access reports and activity.
Log in to your account.
Enrolling your employees.