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Certain web-based member assessment tools are temporarily unavailable. To enroll in the Personal Care Management or SmartStarts Maternity program during this time, please call 1-800-722-2157 and select option 2.

MedCost
Downloadable Forms

Frequently Used Employer Forms

Claims forms are here for your members. If you have questions, please call our Customer Service Contact Center at 1-800-795-1023.

Medical and Dental Claims Forms

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.

Authorization to Release Information

Members can use the following forms to give MedCost permission to share information about themselves (or a dependent) with another person or organization.

Spending Account Reimbursement (FSA)

Reimbursement forms related to your flexible spending account (FSA).

Weekly Disability Income Claim

Members use this form for short-term disability claims.

These forms as well as additonal forms for enrollment are located within your secure account.