To submit a claim via the portal, you will need:
To submit a claim via mail or fax, you will need:
Please note: You may only submit a claim if you have commercial insurance and you are not a participant of Medicare Part B, Medicare Part D, Medicaid, Medigap, VA, CHAMPUS, TriCare or other similar federal or state program.
If you have any questions, please contact the HIBSAGO Copay Program at (844) 817-1220. (8am – 8pm EST, Monday–Friday)