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USC PPO and USC Trojan Care EPO Member Login

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Health Plans

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Member Forms
Download member forms for the USC PPO and USC Trojan Care EPO plans. Available forms include Out-of-Network Claims and Requests for Accident Details.
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Member Forms

Online Forms
Claims — Request for Other Insurance Information
Claims — Request for Medical Information
Claims — Request for Dental Information
Claims — Request for Vision Information
COVID Test
Downloadable Forms
COVID-19 Questionnaire
COVID-19 Questionnaire (Spanish)

Claim Forms

Group Enrollment/Change Form
Group Enrollment/Change Form (Spanish)
Group Medical Claim Form
Group Dental Claim Form
Group Vision Claim Form
COVID Test Claim Form

FSA / Flex Benefits Forms

Flexible Benefits Enrollment/Change Form
Flexible Benefits Plan Claim Form
HRA Claim Form
Direct Deposit Instructions
Eligible Medical Expenses

Health Savings Account

Welcome Guide
Transfer Form

Other Forms

Authorization to Release PHI
Authorization to Obtain Medical Records (Spanish)
Claims - Pre Cert Form
Claims - Request for Accident Details
Claims - Request for Accident Information (Spanish)
Claims - Request for Other Insurance Information
Claims - Request for Other Insurance Information (Spanish)
Claims - Request for Primary EOB/Secondary EOB
Request for HIPAA Certificate
Request for HIPAA Certificate (Spanish)