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
the Claim form by clicking here
Coordination of Benefits (COB)
Coordination of Benefits (COB) is the procedure used to pay healthcare expenses when you or an eligible dependent is covered by more than one health plan. The COB procedure follows the rules established by the laws of the state of Ohio.
Download the Coordination of Benefits form by clicking here
Authorization to Disclose Protected Health Information
To enable spouse, domestic partner, child, power of attorney, guardian, or other person to receive protected health information from EHP related to health plan programs or services.
Download the PHI Authorization form by clicking here