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For questions, please refer to our Frequently Asked Questions page.

Services we offer

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DISABILITY

Fill out the top section and give details about your accident or illness. Your supervisor needs to fill out the middle section, and your doctor will need to fill out the bottom section.

Click to download form

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ACCIDENT

You’ll need to write in the details of your accident, and have your supervisor give details about your time off work. Then your doctor will need to write in your diagnosis and the dates you will be off work. You can fax it to the claims department at the number listed on the claim form, or call the claims department and they will help you file it.

Click to download form

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ILLNESS

If you want to make a claim for your critical illness benefit, fill out the Combined Insurance claim form. You will need to provide them with details about your illness. Your doctor will need to provide information about your treatment as well. You can call Combined’s claims department at the number listed on the form for help with filing your claim.

Download combined Claim Form

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LIFE PLANS

Group Term Life

When a beneficiary needs to make a claim on the member’s plan, call us to find out what paperwork you need to get started. HPD officers can contact Family Assistance to help them get the process going.

Download combined Claim Form

Download Beneficiary Form

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LIFE PLANS

Lifetime Benefit Term (Combined)

If you, the beneficiary, need to make a claim on the member’s plan, use Combined’s Beneficiary Statement for Life Insurance form. If you, the member, need to make a claim for your Long Term Care benefit, use the Combined Insurance claim form.

Download combined Claim Form

Download Beneficiary Form

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DENTAL

Your Dental provider should file a claim for you. However, if you go to a provider that does not file claims for you, use our Dental claim form.

Click to Download Form

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VISION

If you choose an out-of-network vision provider, use the VSP Member Reimbursement Form to make a claim under your plan. Use this form only if you choose a non-network provider.

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contact

1412 Griffin Street East
Dallas, Texas 75215

214-747-6839
214-747-8194
info@dallaspa.org