Contact Us about a Medical Policy

*Indicate required fields.

Complete the form below to send us a question about our Medical Policies. This form is NOT able to provide answers to questions regarding individual benefits, contract issues or precertification issues. For questions related to specific eligibility, coverage, or claims please utilize the secure Member or Provider My Insurance Manager or contact us via the contact information on the individual member’s identification card.

This is not a secure form. Please do not include protected health information.

I am a:*
Health Plan:*
First Name:*
Last Name:*
Practice/Group Name:
(If applicable)
E-mail Address:*
Confirm E-mail Address:*
Daytime Area Code & Phone Number:*( )
Fax:( )
Policy Number: