Home
|
About Us
|
Privacy
|
Contact Us
The best traditions and technologies for managing your health benefits
TPA Services
TPA Customer Service
Claims Processing
Forms
FAQs
Utilization Review
Provider Network
Benefit Design
Pharmacy Benefit Management Services
1-888-779-6872
1 Annie George Drive, Bldg 2
PO Box 3620
Mashantucket, CT 06338-3620
Pequot Health Care
a comprehensive health
and pharmacy benefit
management company
Forms
Select a link below to view the desired form.
Pequot Health Care HIPAA Release
Consent for Information Release – MPTN
Consent for Information Release – Medicare
Employee Change of Mailing Address
Insured Minor Dependent Update
Member Other Health Insurance (OHI) Update
Spouse Other Health Insurance (OHI) Update
Motor Vehicle Accident Report
Flexible Spending Plan Claim
MPTN Family Plan Appeal
© 2009,2010 Pequot Pharmaceutical Network. All rights reserved.