Member Forms
Use our forms to help manage your health plan. If you have any questions, contact Customer Service using the number on your ID card.
Claim Forms
Medical
Mail this form to the address listed on the back of your member identification (ID) card.
Vision
To request reimbursement, please complete and sign the itemized claim form.
Return the completed form and your itemized paid receipts to:
First American Administrators, Inc.
Attn: OON Claims
PO Box 8504
Mason, OH 45040-7111
Prescription Reimbursement Claim Form
For members with one deductible for both covered medical and prescription drug claims. Please Note: Use this form only if you forgot your ID card at time of purchase. You will maximize your benefits and be guaranteed the lowest price when you use your ID card at time of purchase.