PA Chamber Insurance Claim Forms

Claim Forms

Below are claims forms for each of the PA Chamber Insurance carriers. If you do not see the form you need below, please Contact Us.

Carrier	Form
American Sentinel	Claim Filing Instructions Claim Form
Davis Vision	Claim Form
Dearborn National (formerly Fort Dearborn Life Insurance)	Death Claim Form Accelerated Life Claim Form Short Term Disability Claim Form Long Term Disability Claim Form
Dental Network	Claim Form
Guardian Life	Death Claim Form Accelerated Life Claim Form Short Term Disability Claim Form Long Term Disability Claim Form
Harleysville Life Insurance	Claim Form Short Term Disability Brochure Long Term Disability Benefits Claim Form Waiver of Premium Application
HealthAmerica	Medical Claim Form Prescription Drug Claim Form
Highmark Blue Shield	Claim form for all medical coverages
Medco Health	Prescription Drug Claim Form Prescription Drug Medical Request Form Home Delivery Prescription Service Packet Mail Home Delivery Rx forms to: Medco Health P.O. Box 650022 Dallas, TX 75265-9867
NVA	NVA Claim Form
United Concordia	Concordia Flex Dental Claim Form
Unum Provident	Group Life Claim Form