Change Healthcare notifying individuals of data breach. Learn more here.
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 |
| 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) |