Cleveland Clinic Employee Healthplan

claimsform
 

View and print the Claims Form by

clicking on the image below.

Mutual Health Services (formerly Antares) Claims Form
In some circumstances you may be required to pay up front for medical services. For example, if you are traveling outside the country, you may be required to pay for medical services with a credit card or cash. If you should pay up front for a medical service, a manual claim form can be submitted to Mutual Health Services along with the invoice from the provider of service.

http://www.clevelandclinic.org/healthplan/documents/CHNHealthCareClaimFormupdated08.pdf



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