View of downtown Omaha.

Member Forms

Preauthorization 

Some services require a preauthorization before the services are provided to ensure they are medically necessary and a covered benefit under your plan. Download a preauthorization form »

Claims Forms

Use these forms to file a health insurance claim to request reimbursement or direct payment for medical services you received. In-network providers will file claims for you, however, use these forms for out-of-network doctors.

Coordination of Benefits Form 

Your coverage contains a Coordination of Benefits (COB) provision that applies when more than one insurance plan provides you and/or your covered family members with benefits. So we can better serve you, please  fill out this form.