[et_pb_section fb_built=”1″ custom_padding_last_edited=”on|desktop” admin_label=”section” _builder_version=”4.16″ background_color=”rgba(0,0,0,0)” min_height=”618px” custom_padding_tablet=”50px|0|50px|0″ custom_padding_phone=”” transparent_background=”off” padding_mobile=”off” global_colors_info=”{}”][et_pb_row column_padding_mobile=”on” admin_label=”row” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” custom_padding=”0|0px|27px|0px|false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ custom_padding=”|||” global_colors_info=”{}” custom_padding__hover=”|||”][et_pb_text admin_label=”Forms” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” use_border_color=”off” border_color=”#ffffff” border_style=”solid” global_colors_info=”{}”]<\/p>\n
[\/et_pb_text][et_pb_tabs active_tab_background_color=”#ff0032″ active_tab_text_color=”#ffffff” admin_label=”Coverage Tabs” _builder_version=”4.27.4″ tab_font=”|600|||||||” tab_font_size=”15px” background_size=”initial” background_position=”top_left” background_repeat=”repeat” hover_enabled=”0″ border_color_all=”#d8d8d8″ use_border_color=”on” saved_tabs=”all” global_colors_info=”{}” sticky_enabled=”0″][et_pb_tab title=”Medical Forms” _builder_version=”4.27.0″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]<\/p>\n
Sutter Health Plus Medical Claim Form<\/a> United Healthcare Medical Claim Form<\/a> Kaiser Claim Form<\/a><\/p>\n [\/et_pb_tab][et_pb_tab title=”Dental Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]Principal Dental Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=”Vision Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]VSP Vision Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=”Life & Disability Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]Principal Life and AD&D Claim Form<\/a>[\/et_pb_tab][et_pb_tab title=”Voluntary Forms” _builder_version=”4.24.2″ body_font=”||||” body_line_height=”2em” tab_font=”||||” tab_line_height=”2em” body_line_height_tablet=”2em” body_line_height_phone=”2em” tab_line_height_tablet=”2em” tab_line_height_phone=”2em” global_colors_info=”{}”]<\/p>\n To file a claim with American Fidelity please visit\u00a0<\/span>https:\/\/americanfidelity.com\/claims\/<\/a>\u00a0<\/span>or contact your American Fidelity representative listed below:<\/p>\n Gaby Hemphill, GBA [\/et_pb_tab][et_pb_tab title=”FSA Forms” _builder_version=”4.27.4″ hover_enabled=”0″ global_colors_info=”{}” sticky_enabled=”0″]<\/p>\n
Sutter Health Plus Prescription Claim Form<\/a>
Sutter Health Plus Prescription Mail Order Form<\/a><\/p>\n
United Healthcare Prescription Claim Form<\/a>
United Healthcare Mail-Order Prescription Claim Form<\/a><\/p>\n
District Manager, Northern and Central California
American Fidelity |\u00a0<\/span>gaby.hemphill@americanfidelity.com<\/a>
Lic: 0K57332
O: 405-416-8661 | C:510-910-5410<\/p>\n