• Gilsbar Printable Claim Form(español)
• Printable HIPAA Authorization Form
• Supplemental Health Insurance from Nationwide Claim Form
• Gilsbar Printable Subrogation Form
• Dependent Student Medical Leave of Absence Form
• Pan American Life Insurance Company Claim Form
• COBRA Participant Notification Form
• NADA Employee Enrollment Form

Submit your completed Claim Form to:

FAX: (985) 898-1666
MAIL: Gilsbar, LLC
Attn: Claims Department
P.O. Box 2947
Covington, LA 70434-2947