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Excellus
Blue Cross Blue Shield
-
Phone Number: 1-877-381-8659
request ID
card, update address, update policy, etc.
www.excellusbcbs.com
Group
Member Enrollment Form: Additions,
Terminations, Changes, etc.
https://www.excellusbcbs.com/wps/wcm/resources/file/ebb310482ae5674/GEF
040u
02_06.pdf
Student Certification Form:
https://www.excellusbcbs.com/wps/wcm/resources/file/ebb69609e3d9546/student_certification.pdf
Medical Claim Form:
https://www.excellusbcbs.com/wps/wcm/resources/file/ebb74f4581cb503/claim.pdf
Prescription Claim Form FLRX:
Phone number - 1-800-724-5033
https://www.excellusbcbs.com/wps/wcm/resources/file/eb985e05da4161e/msa_09_0408.pdf
Mail Order Express Scripts:
Phone number - 1-877-534-3682
Express
Scripts, Pharmacy Benefit Management (PBM),
Order Prescriptions, Workers' Compensation
GHI
- Group Health Insurance
-
Phone Number -
1-800-624-2414
claim status,
print new cards, update address etc.:
www.ghi.com
GHI Member Enrollment Form (groups to 50):
http://www.nysbg.com/download/forms/ghi/EmployeeEnrollForm.pdf
Student Certification Form:
http://www.nysbg.com/download/forms/ghi/ghi30.pdf
GHI Medical Claim Form:
http://ghi.com/pdf/hcfa1500.pdf
GHI Pharmacy Store Claim Form:
http://ghi.com/pdf/pbm_ghi_drug_claim
form_2008-06-30.pdf
GHI Pharmacy Mail in Medco Claim Form:
http://ghi.com/pdf/medco_mail_order_form.pdf
General Medco Site:
http:/www.medco.com Conference Associates -
GHI clients - Claims Questions
http://www.nysbg.com
SSA - Support Services
Alliance -
Phone Number - 1-800-252-7911 Health, dental, vision
insurance etc.
Support Services Alliance, Inc - Leading Small
Business Success
First
Ameritas Dental -
Phone Number -
1-800-659-5556
claim status, dental
directory, benefits.
www.firstameritasgroup.com
Dental Eye Care/
Dental Enrollment/Change Form: http://firstameritasgroup.com/apps/assets/content.asp?doc=1074
Dental High/Low Enrollment/Change Form:
http://firstameritasgroup.com/apps/assets/content.asp?doc=1075
First Ameritas Dental Claim Form:
http://firstameritasgroup.com/apps/assets/content.asp?doc=1043
Guardian
-
Phone Number - 1-888-278-4542
dental, 401(k) access accounts, change 401(k)
elections, provider network, customer services.
http://glic.com/home_set.html
401(k) account summary: http://guardianretirement.com
Guardian Dental Claim Form:
http://www.guardianlife.com/employee_benefits/ada.pdf
Guardian Life Claim
Form:
http://www.guardianlife.com/service_center/gg42.pdf
Short Term Disability
Claim Form:
http://www.guardianlife.com/service_center/gg011096.pdf
Long Term Disability
Form:
http://www.guardianlife.com/service_center/nro315.pdf
Statutory Disability:
AFLAC
-
Phone Number - 1-800-992-3522 http://aflac.com
Cancer Claim Form:
http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-00220.pdf I
Injury/Accident Claim
Form:
http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-00198.pdf
Short Term Disability
due to Accident/Injury:
http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-00198.pdf
Short Term Disability
due to Illness/Pregnancy:
http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-2029.pdf
First
Rehab Life Insurance Company of America
-
Phone Number -
1-800-365-4999 vision,
100% solution :
http://firstrehab.com
Life/LTD Enrollment/Change Form:
http://firstrehab.com/downloaddocument/forms/GDSNYF2.pdf
Vision Enrollment/Change Form:
http://firstrehab.com/downloaddocument/forms/GVCNYF1.pdf First Rehab Vision
Claim Form:
http://firstrehab.com/downloaddocument/forms/GVCNYF2.pdf
100% Solution Claim
Form:
http://firstrehab.com/downloaddocument/forms/GMRNYF2.pdf
Disability Claim
Form:
http://firstrehab.com/downloaddocument/forms/DBLNYF2.pdf
UNUM -
Phone Number -
1-800-858-6843 For Employees 1-800-421-0344
critical illness policy:
http://unum.com Claim Instructions
for Disability, Life etc.
disability insurance, life insurance, supplemental
insurance, cancer insurance, accident insurance,
long term disability, LTD, long term care, short
term disability, group disability, benefits
administration, income protection, individual
coverage, group cove
Business Council Of N
Y S - Phone Number - 1-800-692-5403
Dental, Vision, Disability, etc:
The Business Council
Dental General:
http://ny.yourdentalsolutions.com/bcnys
Dental Enrollment Form:
http://www.bcnys.org/pdf/forms/dentalenrollment.pdf
Dental/Eye Care Enrollment/Change Form: http://firstameritasgroup.com/apps/assets/content.asp?doc=1074
Dental High/Low Enrollment/Change Form:
http://firstameritasgroup.com/apps/assets/content.asp?doc=1075
Claim Forms:
Insurance Forms - The Business Council of New York
State, Inc.
United Health Care -
Phone Number - 1-888-842-4571 Health Insurance
myUHC.com
MVP
- Phone Number
- 1-800-
Health Insurance etc:
Welcome to
MVP Health
Forms:
MVP Health Care - Members - Forms
National Benefit Life
- Phone Number - 1-716-652-4604 added when it becomes available
MetLife
- Phone
Number - 1-800-275-4638
Metropolitan Life Insurance
Online Change Of Address:
Forms Library - MetLife Dental Claim
Form:
https://eforms.metlife.com/wcm8/cmsclient/eForms_PROD_Deployment/3400/3226.pdf
The Hartford
:
Phone Number - 1-800-547-5000
The Hartford Group
Life and disability
claims:
The Hartford Group Benefits - Claim Questions
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