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 Health Care Spending Account Reimbursement Voucher/Claim Form First Report of Injury (Workers Comp FROI-1 Form) Request for Temporary Total Compensation (Workers Comp C-84 Form)