CANCER CLAIM FORMS

Please read your policy closely.

Cancer policies provide specified benefits for certain treatments, procedures, and services rendered to the policyholder for the treatment of cancer. These limited benefit policies only pay benefits for those items listed in your policy and they do not pay for all treatments, procedures, or services you may receive with your cancer treatment.

Please take a moment to read these important and helpful guidelines regarding how to file your cancer claim.
 

•  Cancer Claim Fax Cover Sheet
•  Cancer Screening Benefit Form
•  First Occurrence Benefit Form
•  Cancer Claim Form (Former Colonial and Life of Georgia policies)
•  Cancer Claim Form (all other policies)
•  Premium Waiver Form
•  Transportation/Mileage Reimbursement Form

Other Forms

• Affidavit of Lost Policy Form
• Bank Draft Authorization Form (In English) / (en Español)
• Beneficiary Change Form
• Health Policy Cancellation Form
• HIPAA Form (release PHI from provider) / Other HIPAA Form (release PHI to agent, family member, other 3rd party)
• Persistency Bonus/Return of Premium Surrender
• Policy Service Form
• Wellness Claim Form