How to Submit a Claim: Step by Step Guide

1.  Go to, then click on "Claimant's Statement."

If you are submitting a claim for a Short Term Medical Plan (STM) please select your state before downloading the appropriate form(s).

If you experience multiple illnesses, please submit a claim form for each illness. For example, if you experience a sinus infection and suffer later from gastrointestinal issues, you will need to submit two claim forms.

Depending on your claim, you may also need one or more of the following forms:

Non-U.S. Claim Form - If you are submitting a claim outside the United States, please fill out and include the Non U.S. Claim Form
Dental Claim Form - Submit if you have a claim that requires dental care
Accident Questionnaire - Submit in addition to your claim form if you were injured during an accident (such as falling, sports injury, motor vehicle accident, etc.)
Trip Cancellation Series - Submit if you purchased Trip Cancellation coverage and experienced an unexpected situation involving your trip.

screenshot of downloads page


2.  When the claimant's statement (or other form) is open, click the download button in the top right hand corner. It will look like a piece of paper with an arrow pointing down as shown below:

screenshot of claimant's statement


3.  Fill out the form completely by printing and filling out by hand, or you may fill it out on your computer if possible.


4.  Go to, then click on "Go to Claims"

screenshot of customer service page


5.  Fill out all information in the claims help request and upload the completed Claimant's Statement from steps 3 and 4.

*Include the Non U.S. Claim Form (from Step 1) if your claim is outside the United States

screenshot of customer service form


6.  Click the Submit button at the bottom of the page. Your claim has been submitted!

Tokio Marine HCC - Medical Insurance Services Group (MIS Group) is a service company and a member of the Tokio Marine HCC group of companies. We are regulated by the State of Indiana in our capacity as Third Party Administrator. Tokio Marine HCC - MIS Group has authority to enter into contracts of insurance on behalf of the Lloyd's underwriting members of Lloyd's Syndicate 4141, which is managed by Tokio Marine HCC – International Group.