Benefit Services Group
142 Arcade St.
P.O. Box 6147
Watertown, NY 13601
1-800-471-4767
315-786-0201
FAX: 315-779-9925
 
  



 

 
 

Text Box: For Employee/Member Use           

WELCOME to the new interactive BSG website. For your convenience, you can access account and claim information for your Flexible Spending Account(s), Max105 health insurance and/or HSA(s) administered by BSG. You may also access necessary forms for these benefits.

Login to the right to access your Account Information.

Flexible Spending Accounts, HSA or  MAX105
Account Information.
 

Access all forms for FSA, HSA, and MAX105 below.

To access your private Account Information please enter your Login ID and Password below.

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Health Claims
Reimbursement Accounts
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ORDER ID CARDS…

DOWNLOAD FORMS…

401(k) ACCOUNT ACCESS…

PROVIDER LISTINGS…






 
ADDRESS CHANGES: Address changes for the Flexible Spending Accounts, MAX105 health insurance, or Direct Dental may be E-MAILED to: barb@benefitservicesgroup.net
 
For your convenience, we have also provided links to a number of outside carriers. Our clients can now easily access forms, provider networks, order ID cards, etc. To use this feature, click on the web address for the insurance company.

Excellus Blue Cross Blue Shield - Phone Number: 1-877-381-8659 request ID card, update address, update policy, etc.  www.excellusbcbs.com    Medical Claim Form: https://www.excellusbcbs.com/wps/wcm/resources/file/ebb74f4581cb503/claim.pdf     Prescription Claim Form FLRX:  Phone number  - 1-800-724-5033 https://www.excellusbcbs.com/wps/wcm/resources/file/eb985e05da4161e/msa_09_0408.pdf    Mail Order Express Scripts:   Phone number  - 1-877-534-3682  Express Scripts, Pharmacy Benefit Management (PBM), Order Prescriptions, Workers' Compensation

 

GHI - Group Health Insurance - Phone Number - 1-800-624-2414    claim status, print new cards, update address etc.: www.ghi.com              GHI Medical Claim Form:  http://ghi.com/pdf/hcfa1500.pdf                            GHI Pharmacy Store Claim Form: http://ghi.com/pdf/pbm_ghi_drug_claim form_2008-06-30.pdf                                                                                 GHI Pharmacy Mail in Medco Claim Form: http://ghi.com/pdf/medco_mail_order_form.pdf  General Site: http:/www.medco.com Conference Associates - GHI clients - Claims Questions
http://www.nysbg.com

 

SSA - Support Services Alliance - Phone Number - 1-800-252-7911 Health, dental, vision insurance etc. Support Services Alliance, Inc - Leading Small Business Success

 

First Ameritas Dental - Phone Number - 1-800-659-5556 claim status, dental directory, benefits.  www.firstameritasgroup.com                                                                      First Ameritas Dental Claim Form: http://firstameritasgroup.com/apps/assets/content.asp?doc=1043

 

Guardian - Phone Number - 1-888-278-4542 dental, 401(k) access accounts, change 401(k) elections, provider network, customer services. http://glic.com/home_set.html                                                                      401(k) account summary: http://guardianretirement.com                       Guardian Dental Claim Form: http://www.guardianlife.com/employee_benefits/ada.pdf                                    Guardian Life Claim Form: http://www.guardianlife.com/service_center/gg42.pdf Short Term Disability Claim Form: http://www.guardianlife.com/service_center/gg011096.pdf                                    Long Term Disability Form: http://www.guardianlife.com/service_center/nro315.pdf  Statutory Disability: 

 

AFLAC - Phone Number - 1-800-992-3522  http://aflac.com                                                                                      Cancer Claim Form: http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-00220.pdf                                                                        I   Injury/Accident Claim Form: http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-00198.pdf              Short Term Disability due to Accident/Injury: http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-00198.pdf              Short Term Disability due to Illness/Pregnancy:  http://www.aflacny.com/us/en/docs/policyholders/claimforms/NY-S-2029.pdf

 

First Rehab Life Insurance Company of America - Phone Number - 1-800-365-4999  vision, 100% solution :  http://firstrehab.com              First Rehab Vision Claim Form: http://firstrehab.com/downloaddocument/forms/GVCNYF2.pdf                               100% Solution Claim Form: http://firstrehab.com/downloaddocument/forms/GMRNYF2.pdf                          Disability Claim Form:  http://firstrehab.com/downloaddocument/forms/DBLNYF2.pdf

 

UNUM - Phone Number - 1-800-858-6843 critical illness policy:  http://unum.com  Claim Instructions for Disability, Life etc. :  disability insurance, life insurance, supplemental insurance, cancer insurance, accident insurance, long term disability, LTD, long term care, short term disability, group disability, benefits administration, income protection, individual coverage, group cove

 

Business Council Of N Y S - Phone Number - 1-800-692-5403      Dental, Vision, Disability, etc: The Business Council                                           Dental General: http://ny.yourdentalsolutions.com/bcnys                               Claim Forms:  Insurance Forms - The Business Council of New York State, Inc.

 

United Health Care - Phone Number - 1-888-842-4571 Health Insurance Health Insurance Claim Form:

 

MVP - Phone Number - 1-800- Health Insurance etc: Welcome to MVP Health       Forms:  MVP Health Care - Members - Forms

 

National Benefit Life - Phone Number -  added when it becomes available

 

MetLife - Phone Number - 1-800-275-4638  Metropolitan Life Insurance                   Dental Claim Form: https://eforms.metlife.com/wcm8/cmsclient/eForms_PROD_Deployment/3400/3226.pdf

 

The Hartford : Phone Number - 1-800-547-5000 The Hartford Group                   Life and disability claims: The Hartford Group Benefits - Claim Questions