Claims

For questions, please refer to our Frequently Asked Questions page.

HPOU Member Benefit Reimbursement

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Medical Supplement for Active Officers

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Medical Supplement for Retired Officers

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Disability

Fill out the top section and give details about your accident or illness. Your supervisor needs to fill out the middle section, and your doctor will need to fill out the bottom section.

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Accident

You'll need to write in the details of your accident, and have your supervisor give details about your time off work. Then your doctor will need to write in your diagnosis and the dates you will be off work. You can fax it to the claims department at the number listed on the claim form, or call the claims department and they will help you file it.

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Illness

If you want to make a claim for your critical illness benefit, fill out the Combined Insurance claim form. You will need to provide them with details about your illness. Your doctor will need to provide information about your treatment as well. You can call Combined's claims department at the number listed on the form for help with filing your claim.

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Life Plans

Group Term Life

When a beneficiary needs to make a claim on the member's plan, call us to find out what paperwork you need to get started. HPD officers can contact Family Assistance to help them get the process going.

Lifetime Benefit Term (Combined)

If you, the beneficiary, need to make a claim on the member's plan, use Combined's Beneficiary Statement for Life Insurance form. If you, the member, need to make a claim for your Long Term Care benefit, use the Combined Insurance claim form.

Download Combined Claim Form
Download Beneficiary Form

Dental

Your Dental provider should file a claim for you. However, if you go to a provider that does not file claims for you, use our Dental claim form.

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Vision

If you choose an out-of-network vision provider, use the VSP Member Reimbursement Form to make a claim under your plan. Use this form only if you choose a non-network provider.

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Contact

1600 State Street
Houston, Texas 77007
Call: 832-200-3410
Fax: 832-200-3470
info@policetrust.com
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