PAI - The TPA with your needs in mind.

Claim Forms

  • Claim Forms
    • Simply Med/Rx Home
    • Member Benefits
    • Find a HealthCare Provider
    • Find a Pharmacy
    • Check Your Status / Claim Information
    • Forms
      • Caremark Forms
      • Claim Forms
      • Eligibility Forms
      • HIPAA Privacy Forms
      • Pre-existing Condition Forms
    • How to Read Your Explanation of Benefits (EOB)
    • Link to EssentialClient.com

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Dental Claim Form

Disability Proof of Loss 

Eye Exam Claim Form

Medical Claim Form 

Missed Premium Direct Payment Form

Missed Premium Direct Payment Form (Spanish)

Life and Accidental Death Claim Form

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