Electronic Forms

The Forms option allows you to create and submit Medica health care forms electronically or to print them for submission through the mail. You can also request a new ID card. To save time, each form is pre-filled with information from your User Profile

Electronic Forms (To fill in and submit electronically)

	ID Card Request
	Change My Primary Care/Home Clinic

Printable Forms (To print and mail)

	Change Form for Medica Direct HSASM & Medica Direct ValueSM
	Change Form for Medica SoloSM & Medica EncoreSM
	Statement of Claims
	Prescription Claim Print Form
	Travel & Lodging Expense Reimbursement Form