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Manhattan Insurance Group offers one of the most complete Product Portfolios in the industry.
It is designed to meet the needs of Worksite, Group and Individual clients.
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Health and Accident
Health and Accident Forms
Claim Forms
Accident Claim Fax Cover Sheet
Critical Illness Claim Form
Disability Claim Form
Medical Illness Claim Form
Medical Accident Claim Form (In English)
/
(en Español)
Premium Waiver Form
Other Forms
Affidavit of Lost Policy Form
Bank Draft Authorization Form (In English)
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(en Español)
Beneficiary Change Form
Health Policy Cancellation Form
HIPAA Form
(release PHI from provider) /
Agent HIPAA Form
(release PHI to agent) /
Family HIPAA Form
(release PHI to Family Member/Other 3rd Party)
Persistency Bonus/Return of Premium Surrender
Policy Service Form
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Manhattan Insurance Group
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Coverage may be underwritten by The Manhattan Life Insurance Company, Family Life Insurance Company, Central United Life Insurance Company, or Investors Consolidated Insurance Company. The information contained on this Web Site does not constitute investment advice, and is not an offer to sell or a solicitation to buy any security or any insurance product. All insurance and/or securities transactions require signed agreements between the companies of Manhattan Insurance Group and its customers, and the terms of those agreements are binding on the parties. No other representation, whether made in person, online, electronically, in written, graphical, or verbal communication, may alter the terms of those agreements except that your use of this Web Site constitutes your agreement to the additional Terms of Use applicable to such use. Some products may not be available in all jurisdictions. In addition, any prospectus information available on this Site is posted for informational purposes only.