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Medical Claim Forms
Medical claims before 7-1-2025
Medical Claim form for Out-of-Network Provider
Directions on Submitting Medical Claim form to HNAS
Phone: 800-220-2600
Website: www.myhnas.com
Email: claims.hnas@hnas.com
Group: U44
Medical claims on and after 7-1-2025
Blue Shield of CA - Out of network claim form.
Connect team customer service: 888-499-5532
Click here for additional Blue Shield details.
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Dental Claim Form
The Dental Claim form applies to the Dental PPO plan Only. If your dentist is an out-of-network provider and does not submit your service to the insurance company, please complete form to receive your dental benefit.
Directions on Filing Dental Claim Form
Phone: 800-765-6003
Website: deltadentalins.com
PPO Group number: 00511
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Vision VSP Claim Form
Submit a claim with VSP if you visit an Out-of-Network provider.
Directions to filing a VSP claim
Phone: 800-877-7195
Website: www.vsp.com
Group number: 30058404
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FSA Tax Spending Claim Form
If you did not use your FSA debit card or if HNAS requires documentation for the debit card you used, please submit documentation or claim to the FSA website.
Directions on Setting up an Account with HNAS FSA
Filing medical or dependent care claim.
FSA Customer Service Number: 800-518-8332
Email: hnasfsaclaims@hnas.com
Website: HNAS.wealthcareportal.com
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