Employee Services >> How To File a Manual/Fax Claim

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How To File A Claim

1. Complete and sign a claim form. "Click here” to download a claim form.

2. Attach documentation (must include date of service, nature of the expense and dollar amount).

3. Mail or fax your completed claim form and documentation to DBS, Inc.


Mailing Address: Diversified Benefit Services, Inc. P.O. Box 260, Hartland, WI 53029

Fax Number: (262) 367-5938