Card Back Card Front
 
 
 
If you need to file a claim, we recommend you submit the form through the Member Portal. It is the best way to check the status of a claim and manage all your plan needs. If the form you need is listed below, you can click on the links to download a PDF version.
 
General Forms
 
Appeals
Application for Individual Coverage
Direct Billing Request
Disability Claim
Electronic Deposit and Wire Transfer
FAQ
Group Medical Health Statement
Life Claim
 
Life Insurance Beneficiary
Maternity Questionnaire
Medical Accident Questionnaire
Medical Claim
Medical Release
Personal Representative Appointment
Pre-authorization
Transition of Care Application
 
 
  
 
 
Card Back Card Front
   
The TieCare Member Portal is the single destination for managing all your insurance needs. You can submit or track claims, request pre- authorizations, and find your plan details via app or web.  
 
For any missing forms, get in touch with TieCare Assist at customerservice@tiecare.com or the numbers below.
 
  
 
 
 
24/7 MEMBER SUPPORT
USA/Canada Toll-Free: +1-855-6TIECARE (6843-2273)
Worldwide Collect: +1-786-814-40TC (4082)
Korea Toll-Free: +00.308.491.0254
customerservice@tiecare.com
assist@tiecare.com / eclaims@tiecare.com		   Home
Coverage
Team
Member Portal
Contact Us
Forms