Trustmark Insurance Individual Medical-Customer Service

Individual Medical Customer Service

Customer Service

Customer Service

As a policyholder with Trustmark Insurance, take advantage of our convenient services. Fill your prescription drug orders online or look up a network doctor, hospital or pharmacy in your area.

If you have questions about your current policy, you may e-mail us at IMcustomerservice@trustmarkins.com.

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State Confidentiality Notices

State Precertification Requirements
- Colorado - Statistics on Pre-Certification approval and denial rates
- Tennessee - Clinical Review Criteria
- Tennessee Tennessee Pre-Certification Requirements by Plan:
- Telemed 3 - Issued from 1989 through 1996 w/2007 Amendment
- Telemed 5 - Issued from 1997 through 1999
- Medstar - Issued from 2000 through 2001
- Medstar - Issued from 2000 through 2001 w/2007 Amendment
- Luminare Health provides pre-certification for some of the services listed in the Policies above. For further information about clinical review criteria utilized by Luminare Health, visit https://www.luminarehealth.com/what-we-do/products-and-solutions/forms.
- Texas - Clinical Review Criteria
- Texas - Prior Authorization Request Form for Health Care
- Texas - Statistics on Pre-Certification approval and denial rates
- Texas Pre-Certification Requirements by Plan:
- AAL (Form Number 4945TX)
- AIA (Form Number TM5AC)
- MedStar (Form TM5-IK)
- TM3 (Form Number Tele-Med TX)
- TM5 group (Form Number TM5_C)
- If you are unsure what plan you have, contact us at (800) 366-6663, or look at the bottom left of your policy/certificate to find the Form Number.

State External Review Request Forms
- Nebraska External Review Request Form

Individual Medical Contract Forms
- (Click your appropriate form or form that is state specific to view contract)
- Form 26
- Form 29 (Legal size)
- Form 46
- Form 50
- 9-675
- MM73
- 949
- POI-W
- H1-MM-1A
- H1-MM-1B
- 4450
- CMM-375, CMM-180
- MM2-985
- GHIAS PPO PLAN A GA
- GHIAS PPO PLAN B GA
- GMC-180 CO
- GMC-180 GA
- GNM-186 NY
- STD/CONV-I/K FL
- OHIO STANDARD PLAN
- 4700
  - 4700
  - 4700FL
  - 4700IL
  - 4700MN
- 4880
  - 4880NE
- 4900
  - 4900SC
- 4906
  - 4906MN
- 4945
  - 4945CO
  - 4945DC
  - 4945FL
  - 4945IA
  - 4945ID
  - 4945MN
  - 4945MO
  - 4945MS
  - 4945ND
  - 4945NE
  - 4945NH
  - 4945NM
  - 4945PA
  - 4945TX
  - 4945VA
- AGA7-77
- TELE-MED
  - Colorado
  - Delaware
  - Florida
  - Illinois
  - Indiana
  - Louisiana
  - Massachusetts
  - Maryland
  - Minnesota
  - Nebraska
  - North Carolina
  - Oregon
  - Pennsylvania
  - South Dakota
  - Tennessee
  - Texas
  - Utah
  - West Virginia
- TM5A/C - Agritrust 2000
  - Indiana
  - Iowa
  - Kansas
  - Missouri
  - Mississippi
  - Montana
  - Nebraska
  - North Dakota
  - Oregon
  - Texas
- TM5/C - Medstar Group
  - California
  - Colorado
  - Illinois
  - Iowa
  - Nebraska
  - Ohio
  - Tennessee
  - Virginia
  - Wisconsin
- TM5/C - Telemed 5 Group
  - Colorado
  - Illinois
  - Ohio
  - Tennessee
  - Texas
  - Virginia
  - Wisconsin
  - Wyoming
- TM5-I/K - Telemed 5 Individual
  - Arkansas
  - Florida
  - Georgia
  - Illinois
  - Indiana
  - Kansas
  - Maryland
  - Minnesota
  - Texas
- TM5-I/K - Medstar Individual
  - Georgia
  - North Carolina
  - South Dakota
  - Texas
Confidential Communication Forms

General Notification of Drug Formulary

New York Drug Formulary

North Carolina Drug Formulary

Colorado Emergency & Non-Emergency Services Disclosure

Federal Disclosure Notice: Patient Protections Against Surprise Billing

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