Members
Member Forms
Online Forms
Claims — Request for Other Insurance Information
Claims — Request for Medical Information
Claims — Request for Vision Information
Downloadable Forms
COVID-19 Questionnaire
Claim Forms
Group Enrollment/Change Form
Group Enrollment/Change Form (Spanish)
Group Medical Claim Form
Group Dental Claim Form
Group Vision Claim Form
FSA / Flex Benefits Forms
Flexible Benefits Enrollment/Change Form
Flexible Benefits Plan Claim Form
HRA Claim Form
HRA Enrollment/Change Form
Direct Deposit Instructions
Direct Deposit Authorization
Direct Deposit Cancellation
Eligible Medical Expenses
Health Savings Account
Welcome Guide
Transfer Form
Other Forms
Authorization to Release PHI
Authorization to Obtain Medical Records (Spanish)
Claims - Pre Cert Form
Claims - Request for Accident Details
Claims - Request for Accident Information (Spanish)
Claims - Request for Other Insurance Information
Claims - Request for Other Insurance Information (Spanish)
Claims - Request for Primary EOB/Secondary EOB
Request for HIPAA Certificate
Request for HIPAA Certificate (Spanish)
PCP Selection
Member benefits
We break down benefits into clear, easy-to-understand language, so members can make the right care decisions. With our integrated services, members are fully equipped to make the most out of their benefits. It’s comprehensive care without the confusion.
HCOnline mobile app—
A total healthcare experience!

- Access a centralized space for managing medical, dental and vision plans
- Check plan status, review coverage, access their ID card, review claims, and submit forms all in one place
- Send questions directly to a Benefits Assistant who can answer questions quickly and accurately
Talk to a real person

How we work with members
Simplified communications
No more jargon. We break down benefits into clear, easy-to-understand language, empowering members to make the right care decisions.
An integrated benefits platform
With our integrated services, members can look up their coverage, check their deductible, review EOBs, and access their ID cards effortlessly all in our HCOnline platform.
Flexibility unmatched
Members have access to wellness programs, care management, flexible spending, and so much more.