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Employer Termination/Deletion Form | |
Credit Card Authorization |
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Atlantis Rewards Program Application |
Instructions When Completing Atlantis Heath Plan Claim Form
- Complete Sections 1-13 to the best of your ability
- Complete new form for each member of the family that you are submitting medical expenses
- New forms must be used on subsequent submissions
- Photo-copy or faxes are not acceptable
- Mail claims to address listed on upper right corner of HCFA 1500 form
- Adherence to these guidelines will enable us to process your claims in at timely manner.
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Health Insurance Claim Form (HCFA 1500) |
If you have any questions contact our Member Services Department at 1-866-747-8422. Member claims should be mailed to 39 Broadway, Suite 1240, New York, NY 10006.
