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

Davis Vision Website

Member Services: (800)999-5431

Links:

Provider Search

Delta Dental Website

Member Services: (877)472-2669

Enrollment Fax: (415)874-3960

Forms:

Member Enrollment/Change Form

Links:

Provider Search

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