Please use this secure form for sending personal or confidential information. You may use this form to:
Send personal credit card or bank account information.
Provide updates on your health condition or changes in conditions.
Make change requests to your current plan or account information.
Submit claim forms and/or confidential medical records.
All information will be stored in an encrypted and secured database until it is ready to be accessed by a support representative. You will also receive a confirmation email along with a unique reference ID which can be used to track your message.
You will receive an email immediately after your form submission which will include a unique ID you can use for reference. Your message will be stored in our encrypted database until a support team member reviews and sends you a reply. If you have not received a reply within 2-3 business days, you may inquire about the status of your request by phone. You will need to provide your unique ID to assist us in locating the relevant information.
You may enter an additional recipient email address but this will only be used to better determine which support team your message will be routed to. If your message needs to be routed to a specific email address, please enter additional details in the message area.
If you need to send personal information such as medical records, payment information, etc., please use our Secure Message Center.
Please Note: This form is for general inquiries only. If you are trying to send any private or personal information that may disclose payment, medical, claims or any other sensitive data, please use our encrypted Secure Message form.
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