Forms

Below are some frequently used forms provided as a convenience to our members, employers, consultants/brokers and 
providers.  If you are an employer accessing this site, please contact service@claimlinx.com to gain access to your Employer Portal.  

All forms are formatted in Adobe Acrobat Reader. If you do not have Adobe Acrobat Reader Download Adobe for free here.

Member Packet - No RX

Information packet for ClaimLinx members who have MERP medical coverage, but do NOT have additional prescription drug coverage. Read only if your ClaimLinx ID card matches the one pictured (see left). 

Member Packet - RX Reimbursement

Information packet for ClaimLinx members who have MERP medical coverage and additional MERP prescription drug coverage. Read only if your card matches the one pictured (see left). 

Member Packet - RX Reimbursement with PBM Plus Not Applicable

Information packet for ClaimLinx members who have MERP medical coverage and additional MERP prescription drug coverage. Read only if your card matches the one pictured (see left). 

Member Packet - PBM Plus No Coordination of Benefits

Information packet for ClaimLinx members who have MERP medical coverage and prescription drug coverage administered through PBM Plus, with no coordination of benefits with their primary insurance. Read only if your card matches the one pictured (see left). 

Member Packet - PBM Plus With Coordination of Benefits

Information packet for ClaimLinx members who have MERP medical coverage and prescription drug coverage administered through PBM Plus, with a coordination of benefits with their primary insurance. Read only if your card matches the one pictured (see left). 

Member Packet - ApproRx No Coordination of Benefits

Information packet for ClaimLinx members who have MERP medical coverage and prescription drug coverage administered through ApproRx, with no coordination of benefits with their primary insurance. Read only if your card matches the one pictured (see left). 

Member Packet - ApproRx With Coordination of Benefits

Information packet for ClaimLinx members who have MERP medical coverage and prescription drug coverage administered through ApproRx, with a coordination of benefits with their primary insurance. Read only if your card matches the one pictured (see left). 

Change of Address Form (Providers & Members)

Please fax or mail to process your request.

ID Card Request Form

Please fax or mail to process your request.

How a Claim is Processed

Please fax or mail to process your request.

ClaimLinx specializes in the benefit administration of self-funded medical expense reimbursement plans (MERP).  Specifically, ClaimLinx administers Section 105 health plans that combine a high deductible health plan with employers self-funding a portion of the benefit plans.  ClaimLinx can assist in consulting services as well as the design of the benefit plan, process claims, educate members and pay providers.

Eliminate the hassle of administering a self-funded benefit plan by contacting us. 
Our experienced staff is eager to coordinate a benefit plan that is right for you!