Forms

Medical Forms
Dental Forms
Vision Forms
Life & Disability Forms
Voluntary Forms
FSA Forms

Sutter Health Plus Medical Claim Form
Sutter Health Plus Prescription Claim Form
Sutter Health Plus Prescription Mail Order Form

United Healthcare Medical Claim Form
United Healthcare Prescription Claim Form
United Healthcare Mail-Order Prescription Claim Form

Kaiser Claim Form

Principal Dental Claim Form

VSP Vision Claim Form

Principal Life and AD&D Claim Form

To file a claim with American Fidelity please visit https://americanfidelity.com/claims/ or contact your American Fidelity representative listed below:

Gaby Hemphill, GBA
District Manager, Northern and Central California
American Fidelity | gaby.hemphill@americanfidelity.com
Lic: 0K57332
O: 405-416-8661 | C:510-910-5410

Claim Form