Veterinary Pet Insurance

Claim Forms

Please select the appropriate form for your state.

Colorado (112 KB)

Nebraska/Oregon/Vermont (112 KB)

New York (112 KB)

Ohio (112 KB)

Oklahoma (112 KB)

Tennessee (112 KB)

Virginia (112 KB)

All Other States (112 KB)

How to file a claim

Claim Review Form

This form may be used as a cover sheet for your request to review a completed claim or an exclusion

Claim Review Form (74 KB)

Medical Benefit Schedules Please choose the form applicable to your state of residence
HI, NY, SC, WA
	Superior Plan Benefit Schedule (104 KB)

	Standard Plan Benefit Schedule (100 KB)

	Avian and Exotic Plan Benefit Schedule (97 KB)
All Other States
	Superior Plan Benefit Schedule (104 KB)

	Standard Plan Benefit Schedule (100 KB)

	Avian and Exotic Plan Benefit Schedule (97 KB)

Pet WellCare Protection Benefit Schedules

Pet WellCare Protection Core Coverage (24 KB)

Pet WellCare Protection Premier Coverage (24 KB)

Vaccination & Routine Care Coverage (26 KB)

Hospital Forms

Physical Examination Record Form (165 KB)

Hospital Sign-In Sheet (14 KB)

Refer-A-Friend Form

Refer-A-Friend Form (32 KB)

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