Below you find links to form available for filing claims and making changes to your benefit plans.  Please contact EBS if you have trouble locating the form you need.

Please note: If a claim form does not include information on where to send it, check the back of your Plan ID card for the address.  If you are unable to locate your ID card, or still have questions after reviewing it, please contact EBS directly.

*All in-network providers will file a claim on patient's behalf; claim forms only necessary for out-of-network expenses.

DENTAL
Delta (NY) – Enrollment - Contact EBS directly for form
Delta (NY) – Claim
Guardian – Enrollment
Guardian – Claim
First Ameritas – Enrollment
First Ameritas – Claim

LIFE INSURANCE
Guardian – Enrollment
Guardian – Claim
Guardian – Name/Beneficiary Change
US Life – Enrollment
US Life – Claim
US Life – Name/Beneficiary Change

DISABILITY
Guardian – Enrollment
Guardian – Long-term disability claim
Guardian – Short-term disability claim 
UNUM – Long-term & short-term disability enrollment (small group – 9 or less employees) 
UNUM – Long-term & short-term disability enrollment (large group – 10 or more employees)
UNUM – Claim

FLEXIBLE SPENDING ACCOUNT
Flex election change
Flex medical & dental expense guide
Flex dependent care expense guide
Transit & parking expense guide
Flex claim form & instructions (form to be used for any flex claim: medical, dental, dependent care, transit, parking)
Flex Card FAQs 
IIAS Participating Merchants

COBRA
COBRA – frequently asked questions