• Complete and submit this form to file a claim. Click to view the form, and save a copy to access a version with fillable text fields, allowing you to type your responses.

• Complete and submit this form to file a claim. Click to view the form, and save a copy to access a version with fillable text fields, allowing you to type your responses.

• Complete and submit this form to file a claim. Click to view the form, and save a copy to access a version with fillable text fields, allowing you to type your responses.

Please note that the criteria for reimbursement requires that behavioral health services or treatment occurred on or after February 10, 2023. Only one Behavorial Health Claim Form needs to be completed. Once the claim is filed, ongoing behavorial health services can be reimbursed on the initial claim. Receipts for ongoing reimbursement may be submitted to your claim adjuster at Sedgwick.

Send your completed form to claims@cfhtrust.com or contact:

Colorado Firefighter Heart, Cancer & Behavioral Health Benefits Trust
Toll-Free: 1-844-769-6650