OBGYN Associates of Erie has partnered with HealthMark to ensure the accurate and timely completion of FMLA and/or Disability forms.
FMLA and/or Disability forms
Requests may be submitted electronically to HealthMark’s Request Manager at https://requestmanager.healthmark-group.com.
Once logged in, select “Submit Request” from the menu options and enter all required fields to submit a valid authorization. Each form requested for completion will require a $35.00 fee to be paid directly to HealthMark. Please allow up to 5 business days for processing of your request. Typical turnaround for FMLA and Disability forms is 2-3 business days after the $35 fee has been paid.
If an email is provided, you will receive a response directly from HealthMark notifying you of the prepayment invoice. After payment, the completed forms may be downloaded directly through HealthMark's website, or provided directly to you through an agreed upon delivery method (i.e. secure email, mail, etc.).
Status Updates on Your Form Request
All Form Requests are processed by our partnering provider, HealthMark. *Please allow up to 5 business days for processing of your request. Typical turnaround for FMLA and Disability forms is 2-3 business days after the $35 fee has been paid.
If you would like to check the status of your Request, please log into Request Manager where you can get status updates or chat with support. You can also call HealthMark at 1-800-659-4035 or email firstname.lastname@example.org.