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INSURANCE
FORMS
- MetLife
Dental Claim Form (PDF file)
- Empire
Plan Health Insurance Claim Form
(PDF file)
- GHI
Health Insurance Claim Form (Standard HCFA-1500
form in PDF file)
Use this standard Health Insurance
Claim Form for most services. Please mail completed form to
the GHI processing center nearest you:
New York City
GHI
P.O. Box 2832
New York, NY 10116-2832
Albany
GHI
P.O. Box 15030
Albany, NY 12212-5030
For Behavioral Management Program
claims with psychiatrists, psychologists, social workers and
other similar providers, please mail completed form to:
GHI
P.O. Box 2827
New York, NY 10116-2827
For Nursing Services Claims, please
mail completed form to:
GHI
P.O. Box 3000
New York, NY 10116-3000
For Durable Medical Equipment including:
hospital beds, oxygen and oxygen equipment, walkers, wheelchairs,
and other medically necessary durable equipment and supplies,
please mail completed form to:
GHI
P.O. Box 2826
New York, NY 10116-2826
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