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Claim Forms

Dental, Vision, Life & Disability Forms

Review the information below to submit a claim form, as well as browse our available forms.

You or your dentist should send your claims to:

PO Box 17250
Indianapolis, IN 46217
Attn: Claims Department

NOTE: If the member number on your ID card is a six-digit number starting with one, please dial 800-894-4532 for eligibility and customer support.

For questions regarding your dental claim:

Your VSP Doctor will submit claims on your behalf. To submit an Out-Of-Network claim, visit:

For questions regarding your life and disability claim:

Phone: 844-368-6485, Option #2

Review common questions regarding short term and long term disability claims:

Short Term Claim FAQ Flyer

Long Term Claim FAQ Flyer


Short Term Disability Claim Form [STD-101C]

Long Term Disability Claim Form [LTD-101C]

Supplementary Statement of Claim Form [SSC-001C]