July 24, 2017
The Rigg Darlington Group, Inc

Employee Benefits Carriers

The Rigg Darlington Employee Benefits Division works with all of the major carriers in group medical, life, disability, dental, vision, and voluntary benefits.

Below are some of the carriers we work with as well as valuable information regarding each of the carriers.

Logo - Aetna Logo
Aetna Website
  
Member Services: (888)702-3862 or (888)802-3862
  
Forms:
Member Application
HIPAA Form
Medical Claim Form
Dental Claim Form
Mail Order Rx Form
  
Links:
Provider Search
Formulary
 
  
  
Member Services: (800)521-3535
Claims Services: (800)348-4489
Claims Fax: (866)424-8482
  
Forms:
HIPAA Authorization Form
Policyholder Change & Service Request
Critical Illness Claim Form
Group Voluntary STD/LTD/Waiver of Premium Claims
Cancer/Specified Disease/ICU/Heart/Stroke Claims
Hospital Indemnity Claim
Wellness Claims 
  
  
Member Services: (888)868-FLEX (3539)
Member Services Email: service@flex125.com
  
Forms:
Enrollment Form
Claim Form
Direct Deposit Form
Employee Request for Service Form 
  
  
Member Services HMO/POS: (866)681-7373
  
Links:
Find a Provider
Rx Information
  
  
Member Policy Services: (800)733-7879
  
Forms:
Member Application
Member Change Form
Dental Claim Form
STD Claim Form
LTD Claim Form
HIPAA Authorization Form
  
Links:
Provider Search 
  
 
Customer Service: (508)809-6010
Email: info@brokersuite.com
  
Links:
MyBenefitsCount Information
  
 
  
Member Services: (866)686-2242 
Prescription Drug: Express Scripts (800)585-5794
  
Forms:
Member Change/Enrollment Form
Plus Billing Form
HIPAA Member Authorization Form
Waiver of Coverage
  
Links:
Provider Search
Express Scripts
Formulary
 
Logo - Davis Vision
Davis Vision Website
 
Member Services: (800)999-5431
  
Links:
Provider Search
  
 Logo - Delta Dental
Delta Dental Website
  
Member Services: (877)472-2669
Enrollment Fax: (415)874-3960
  
Forms:
Member Enrollment/Change Form
  
Links:
Provider Search
  
Logo - Geisinger 
Geisinger Health Plan Website
 
Member Services Referral Plan: (800)447-4000
Member Services Non-Referral Plan: (800) 504-0443
  
Forms:
Member Enrollment Form
Member Change Form
  
Links:
Provider Search
Rx Formulary Information
  
  
Member Services: (800)685-4542
  
Forms:
Dental Claim Form
STD Claim Form
LTD Claim Form
Physician Statement
  
Links:
Provider Search
 
  
Member Services: (800)523-2233
Enrollment Changes/Term Fax: (888)701-8234
  
Forms:
Enrollment Form
 
  
Member Services: (800)788-8445
  
Forms:
Member Enrollment/Change Form
Employee Termination Form
Rx Claim Form
  
Links:
Provider Search
Formulary
 
  
Customer Service: (800)345-3806  
Merck MEDCO: (800)903-6228 
Fax Number for Adds, Terms & Changes: (717)302-2985 
  
Forms:
Member Change Form
Waiver of Coverage
 
Links:
Provider Search
Formulary
 
  
Member Services PPO: (800)626-8144    
Member Services HMO: (800)227-3114
Member Services POS: (800)253-3854 
  
Forms:
Member Change Form
Waiver of Coverage
HIPAA  Authorization
Rx Mail Order Form
Rx Claim Form
Keystone Transmittal Form
  
Links:
Provider Search
Formulary
 
  
Member Services: (800)492-2385
  
Links:
Member Website
Provider Search
  
 
  
Member Services: (800)423-2765
Enrollment Changes Fax: (877)573-6177
Disability Claims Fax: (877)843-3950
  
Forms:
Member Enrollment Form
Beneficiary Change Form
Dental Claim Form
LTD Claim Form
STD Claim Form
  
Links:
Provider Search 
  
  
Member Services: (800)ASK-4-MET (275-4638)
Enrollment Info Fax: (888)505-7446
  
Forms:
Enrollment Form (all coverages)
Dental Claim Form
Change Request Form
Beneficiary Designation Form
  
Links:
Provider Search
 
  
Dental Member Services: (877)999-2330
Disability Claims: (800)877-5176
  
Forms:
Employee Termination Report Form
Beneficiary Designation
Dental Claim Form
Disability Claim Form
  
Links:
Provider Search
 
  
Member Services: (800)537-4565
  
Forms:
Member Enrollment Form
  
  
Member Services:  (800)247-4695
Rx Caremark: (877)683-6838
Fax: (866)785-
  
Forms:
Member Enrollment Form
Member Change Form
Group Enrollment Change Form
HIPAA Authorization Form
Rx Formulary
  
Links:
Provider Search
 
  
Member Services: (800)638-3120
  
Links:
Provider Search
 
 
Member Services: (800)247-6875
 
Forms:
Member Enrollment Form
Dental Claim Form
Vision Claim Form
List Bill Change Form
 
Links:
Provider Search
 
  
Member Services Group Life: (800)628-8600
Member Services Group LTD: (800)368-1135
Member Services Group STD: (800)368-2859
Member Services Group Dental: (800)547-9515
  
Forms:
Dental Claim Form 
  
  
Member Services: 1-800-332-0366 (PPO)/ 1-866-357-3304 (DHMO)
 
Forms:
Member Application/ Change Form
Member Claim Form
DHMO Change Form
DHMO Referral Claim Form
  
Links:
Provider Search 
  
 
Member Services: 1-800-357-0978 
Fax Adds & Terms: 1-813-818-3724  
 
Forms:
Member Enrollment Form (2-50)
Member Enrollment Form (51-99)
Member Claim Form
Rx Claim Form
Claims Submit Address
 
Links:
Provider Search
Formulary
 
 
Member Services: (800)877-7195
 
Links:
Provider Search