Freedom to Choose™ Health and Dental Insurance
Start a paper claim
Use these forms to request reimbursement for expenses covered by your plan, including vision, dental and prescription drugs. You'll find instructions on how to return the completed form on the form itself.
Standard claim form
Download this form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save.