Insurance Claims
To submit an insurance claim
- Download and print form below.
- Gather all paid medical bills (if you have any at this point)
- Fill out the form (as soon as possible once an incident occurs)
- Submit claim form and bills (you can submit bills later as well)
- Email to Mark Menconi at markmenconi@sbcglobal.net
- Mark will submit the claim form to our supplemental medical coverage carrier.
- You can submit bills as you go along in the process directly to the insurance company
- You can email Mark directly if have any questions regarding the form.
Oops!
You have unsaved elements
Please save or cancel the pending changes to the elements within your page and then try saving again.