Claims Question Contact Numbers Mountain State Blue Cross Blue Shield (Medical Claims) 1-800-344-5123 Cigna (Dental/Vision Claims) 1-800-244-6224 Medco (Prescription Claims) 1-800-820-9730 Life Insurance Beneficary Form Dental Claim Form Vision Claim Form Medical Enrollment and Change Form (MSBCBS) Supplemental Unemployment Benefit (SUB) Application Accident and Sickness Application/Claim Form Flexible Spending Account Reimbursement Request Form First Report of Injury (Workers' Comp FROI-1 Form) Request for Temporary Total Compensation (Workers' Comp C-84 Form) Physician's Report of Work Ability (MEDCO-14) Physician's Report for Medical Service (C-9)