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Insurance Forms

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Insurance

Insurance Referral and Pre-certification Requirements
Senior Advantage Program
Insurance Forms

See below for coordination of benefits questionnaires, medical claim forms and other insurance forms.

Downloadable Forms

  • Aetna Coordination of Benefits Form
  • AmeriHealth Coordination of Benefits Questionnaire
  • CareFirst Coordination of Benefits Questionnaire
  • Cigna Medical Claim Form (English)
  • Cigna Medical Claim Form (Spanish)
  • Kaiser Permanente Coordination of Benefits Form
  • TRICARE® Other Health Insurance Questionnaire
  • UnitedHealthcare Coordination of Benefits Form
  • UMR Employee Questionnaire

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The George Washington University Hospital is owned and operated by a subsidiary of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.

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