OptiMed Product Online Claim Forms
Click the appropriate link from dropdown window and you will access an online form.
Nationwide Product Downloadable Claim Forms
Download onto computer. Forms can be filled out digitally using Adobe Acrobat or other PDF software but will not be fillable in most web browser preview windows.
NOTE: While the forms are "fillable," they can not be submitted digitally unless you scan and email to the address provided on the form (If there is one).
Dental Downloadable Claim Forms
Appealing denial of a health insurance claim is within the jurisdiction of the state in which the policy was issued. Please follow the link above to find your state's method of appeal.
To report the suspicion of fraud or misrepresentation by an insured, provider, agent, or OptiMed Health employee, please send an email to firstname.lastname@example.org. Include a description of the fraud or misrepresentation with as much detail as possible, and if desired, provide your contact information for additional questions.