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How to submit a claim

Instructions about how to file a medical or dental claim.​

Medical/Dental Form to be sent to Audit Committee

​This is the form you need to fill out to submit a claim.

Upload Your Claim

If you scan your Relief Medical/Dental Claim as an Adobe .pdf file you may upload the file here.  Mailing the forms in will not be necessary if they are uploaded.

Insurance Rebate

Every year we take what Interest and Dividends we earn to help our retired members with their Health Insurance Premiums.

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© 2021 by The Rockford Police Relief Association.

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