File a Claim
Group BenExtend Claims

Forms:

Group BenExtend SM Claims

A BenExtend claim requires supporting documentation for review of benefits such as an itemized bill if there was a hospital stay, itemized bill from physician’s office, surgical report if surgery took place, Xray/Diagnostic Test reports with dates and charges if applicable, accident report if applicable, and a signed and dated Authorization for Disclosure of Health Information (HIPAA form).

Please date and sign all required forms where indicated.