Claim Forms

If you need to submit a claim, download the form and choose one of these options:

  • Return the completed form via email here, or
  • Return the completed form via fax to 855-400-9307, or
  • Return the completed form via mail to:
    Claims Department
    P.O. Box 14389
    Baton Rouge, LA 70898-9100
Download Form

Other vision forms:

Grievance From - Request for review and reconsideration of a submitted claim.

AZ Health Coverage Appeal Information Packet - Important information for our members in Arizona about how to appeal decisions Starmount Life Insurance Company makes about your health coverage.

Special Discounts for Optical Members - Reference for special discounts on optical materials provided by Value Added (VA) and Service Plus (SP) providers in the FirstLook Vision Network.

Hearing Savings Plan Flyer - Learn how you can access savings on hearing instruments and accessories.

For additional forms and documents, visit