Request Plan Materials

You can order various Plan materials from our web site via email, such as ID cards, member handbooks and brochures. Just fill out the form below and be sure to indicate which item(s) you would like. If you want to request more than one item, just click the "Back" button after making each request.

Plan Materials You Can View and Print Online
You also have online access to the following items:
  • Benefit Descriptions - View online benefit descriptions that provide detailed information about benefits and coverage for specific services available under the UniCare State Indemnity Plan, such as outpatient laboratory services and preventive care. (updated versions available in July)

    Please refer to the applicable Member Handbook for more information on Plan benefits, conditions, limitations and exclusions.


  • Claim Form - You can complete this form online and print it from your computer. To access the link to the claim form and get information on how to file a claim, click here



Your ID #:
Your Name: (required)
Street Address: (required)
City, State, Zip: (required)
Daytime Phone #: - -
Your Date of Birth (mm/dd/yy): / /
Your Email Address: (required)
Select Item You Are Requesting:




   
 

   

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