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Claims Forms

By clicking on one of the choices below, you may print the form on your computer's printer.

General Forms

General forms apply to all policies.

HomeCare, Family Caregivers

These forms apply to EquiCare 2002 and 2020 policies. Before using these forms please contact the Specialty Unit to inquire about eligibility for benefits.

HomeCare Agency


Facility Claim Forms

If you are unsure of the form number which applies to the policy please call the EquiCenter at 800-352-5170 for assistance.