1. Claim Inquiry Form
All required fields on a screen must be completed before you will be allowed to continue.
Date is automatically populated for you.
Type in your first and last name. The value entered here will be stored for 8 hours, but can be changed at any time.
May I have your name?
If the caller has not identified themselves as the cardholder, ask:
What is your relationship to the cardholder?
Relationship can be CardHolder, Spouse, Child, Other. Choose CardHolder if the caller is actual cardholder. This will auto-populate the Cardholder first and last name fields
May I have the cardholder's name?
You will only have to ask this if the caller is someone other than the Cardholder.
What is the cardholder's home telephone number, with area code?
During the weekday hours of 8 am to 8 pm (Eastern Time), is there a different phone number (besides Home #) that a claims specialist can use to contact you?
After the Phone # you can type in Work, Cell, Fax, etc.
: Do you have an email address that they may use to contact you?
Type NONE or UNKNOWN if applicable
: May I please have your claim Number?
: Based on the information the caller gave at the beginning of the call, you should be able to ask a specific question for the Reason of Call field. Example:
What is the question you have for the claims specialist?
: Rep: You may also type any comments you feel are helpful.
Advise the caller:
A claims specialist will respond to this inquiry within 48 business hours. The response may be via e-mail or phone call. Business hours are considered Monday - Friday from 8am - 8pm eastern time.

When finished, click the "Submit Claim Inquiry" button to submit this inquiry. You may choose Cancel to clear the form and cancel sending.
* Required Field