If you cannot reach us during the day or if you were too busy, we provide this format to help get your questions to us when it's convenient for you.
Want to reach us the old way?
Telephone: (847) 559-8100
Fax: (847) 559-8140
Please fill out the following information
Your Name
Are you the Primary Insured? ( if no please list the name of the primary Insured.
Please list the employers name (if applicable)
Your E-mail address - with the ``@.com"
The Social Security Number of the Primary Insured.
Name of Insurance Company
I need assistance with a ( Please check one or more)
Claim Question
Lost or additional ID Card(s)
General Coverage Question
Specifically related to a problem with : ( Please check one or more)
Medical
Prescription
Dental
Life Insurance
Other
The person affected is: ( Please check one or more)
Insured
Spouse
Child
Child name
If this is about a medical claim:
Please provide the name of the provider, amount of charge, and date of service.
Date:
Provider
Amount
Please provide any other information that will help me help you!
[Home]
[Clients]
[About Us]
We will try and get back to you the next business day
. Copyright 1997 by Castle Group Health Inc. All rights reserved.
Castle Group Health Inc. ; PO Box 2038; Northbrook, IL 60065-2038.
Tel: (847) 559-8100 Fax: (847) 559-8140