Contact Us

Ask general questions, request an identification card, or contact us for a quote for your company. Select an appropriate online form below and submit it to us, or feel free to call us at 800-332-1168.

All information provided here is secured by state-of-the-art encryption.

Fields with an orange outline are required. Please fill in the missing information.

Request a Quote

General Question

Member ID Card Request

Member Third Party Liability Information:

If you received a request from UMR for Third Party Liability Information please complete the form below. By completing this form a determination can be made as to whether CEBT or some other entity is the primary payor responsible for claims that have been submitted.

  • Yes

    No

Member’s Dependent(s) Other Insurance Information:

If you received a request from UMR requesting Dependent(s) Other Insurance Information please complete the form below. By submitting this information a determination can be made as to which coverage is primary for your dependents if they have multiple coverages.

Do any dependents have any other coverage for medical, dental, or vision:

Employer Supply Request

Please complete the form below and we will get the requested supplies to you as soon as possible. Thank you.