Forms

Listed below are forms you may need as a TrueCare™ member.

Claim Refund Check Form : Mail your refund check, this form and any other required documentation to TrueCare.

Tell Us: Use this form when you would like to send us a question. You can also make a complaint, file an appeal or tell us if you have any other insurance other than TrueCare.

Fraud, Waste and Abuse Reporting Form: Use this form if you think that a member, provider, or pharmacy is taking part in fraud, waste, abuse or overpayment.

Grievance and Appeals Form : Use this form if you have a complaint about a service you got or do not agree with a decision we made.

TrueCare Life Services (Coming Soon): Work with our TrueCare Life Services team and coaches. You may need to fill out some of these forms to work with the team.

  • TrueCare Life Services Coaching Consent Form (Coming Soon)
  • TrueCare Life Services Data Use and Disclosure Authorization Form (Coming Soon)
  • TrueCare Life Services Data Disclosure to Employers Form (Coming Soon)
  • TrueCare Life Services Data Disclosure to Community Partners Form (Coming Soon)

Member Claim Form

Member Consent/HIPAA Authorization Form: Use this form to share your health information with your providers or someone else:

Member Services: 1-833-230-2050 (TDD/TTY: 711), Monday through Friday, 7 a.m. to 8 p.m. Central Time (CT).