Employee Participants

Forms

Electronic claim submission is available for you on your mobile or computer device anytime, anywhere- simply log into your account.  There you can upload a claim and submit the receipt/documentation of your eligible expense.  One of the great features of our electronic claims is that we receive the claims quicker, so your claims are already on the "fast track" to processing.  And, you can also quickly track the status of your claim.  What are you waiting for?  Log into your account and check out these tools for yourself. 

If you prefer not to take advantage of our electronic and mobile claim submission, you can also submit a paper claim.  Print and complete the appropriate form below and send to us via fax or mail.  

  • Fax to: Toll-free (877) 855-7105
  • Mail to: P&A Group, 17 Court Street Suite 500, Buffalo, NY 14202

Miscellaneous Forms

HIPAA Authorization Form

download_icon PDF Form

Dependent Care Guidelines

download_icon PDF Form

Letter of Medical Necessity Form

download_icon PDF Form

Benefits Card Request Form
download_icon PDF Form

COBRA/Direct Billing ACH Form

download_icon PDF Form