SAG-AFTRA Forms

Claims and Coordination of Benefits (COB) Submissions

Medical / Hospital

Anthem

(833) 414-5790

Anthem or Sydney Health App

Medical claim form

Call Anthem or

login and go to "Profile", "My Account" and select “Additional Insurance Policies.”

Behavioral Health

Carelon Behavioral Health

(866) 277-5383

Achieve Solutions

Carelon claim form

Carelon COB form

Prescriptions

CVS Caremark

(833) 741-1361

Caremark CVS

CVS Caremark claim form

CVS Caremark COB form

Dental

Delta Dental

(800) 846-7418

Delta Dental

Delta Dental claim form

Call Delta Dental

Vision

Vision Services Plan (VSP)

(800) 877-7195

VSP

VSP claim form

Call VSP

Travel Benefits

SAG-AFTRA Health Plan

(800) 777-4013

Benefits Manager

Travel benefits claim form

N/A