Online Claim Submission
If you prefer to print and mail a claim, please choose your carrier below. Note: Turnaround time for claims submitted electronically is significantly faster.
Pan-American Life printable claim form
Unified Life printable claim form
Update Eligibility (Change Form)
Click here to update contact information, add or term dependents, or make other eligibility changes.
Privacy Rule Authorization
This form is the participant's signed permission to allow a covered entity to discuss or disclose the participant's protected health information (PHI).
Electronic Funds Transfer (EFT) Form
This form is the participant's signed permission to allow BeniComp to reimburse claims directly into their bank account electronically.