Dental Claim

1)       Obtain a Claim Form from your Employer or print an online claim form through the link below.  Refer to your certificate of coverage to obtain the name of your dental Insurance Company.

a.     Michigan Dental Plan:  Attending Dentist's Statement 74-1170

                         Or

b.   Assurity Life Insurance Company:  Attending Dentist's Statement 5046 G - M5 #1

Follow the Employee Instructions on the form for proper filing. Incomplete information will cause a delay in processing or your claim.

2)       Attach all original bills to the completed claim form and forward to:

Group Marketing Services, Inc.

P.O. Box 19040

Kalamazoo, MI 49019-0040

Phone (269) 343-2611

Optical Claim

1)       Obtain a Vision Care Benefit Claim Form.  Follow the Employee Instructions on the form for proper filing. Incomplete information will cause a delay in processing or your claim.

2)       Attach all original bills to the completed claim form and forward to:

Group Marketing Services, Inc.

P.O. Box 19040

Kalamazoo, MI 49019-0040

Phone (269) 343-2611