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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.
