Please be advised, the Employer Portal will undergo maintenance from 3 pm Friday 4/19th to 4 am Monday 4/22nd. The application will be inaccessible during this time.
Preferred Provider Organization (PPO) Claim Forms
If you need a form that is currently not available online, please call Member Services at the telephone number on your ID card.
Major Medical Claim |
Outpatient Pre-Treatment Authorization |
International Claim Form
(For care received out of network area) |
Coordination of Benefits
(Update your information on My Account) |
Disability Certification |
Advanced Directive Information Sheet |
Maryland Advance Directive |
Continuity of Care - Members in a Maryland Based Plan (PDF) |
Continuity of Care - Provider Not in Network (PDF) |