Member Changes & Requests

Below are the most commonly-requested forms for members. Please be sure to send any required receipts or documents along with the completed form for the quickest processing. Documents can be sent by mail to our office, fax at (800) 858-1913 or email at help@claimlinx.com.

ClaimLinx ID Card Request Form
Please send completed form to ClaimLinx for processing. No additional documents required.

Change of Address Form
Please send completed form to ClaimLinx for processing. No additional documents required.

ClaimLinx Prescription Claim Reimbursement Form
Please send completed form to ClaimLinx for processing. Documentation and/or receipts required.

GuidantRx Prescription Claim Reimbursement Form
Please send completed form directly to GuidantRx. Documentation and/or receipts required.

HealthSmart Prescription Claim Reimbursement Form
Please send completed form directly to HealthSmart. Documentation and/or receipts required.

ClaimLinx Medical or Dental Claim Reimbursement Form
Please send completed form to ClaimLinx for processing. Documentation and/or receipts required.

ClaimLinx Vision Reimbursement Form
Please send completed form to ClaimLinx for processing. Documentation and/or receipts required.