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
- Prescription Drug Claim Form
- Wellness Claim Form
Home Health Care (HHC) Claim Forms
Short-Term Care (STC) Claim Forms
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)
- HIPAA Form (release PHI to agent, family member, other 3rd party)
- Persistency Bonus/Return of Premium Surrender
- Policy Service Form
EASY UPLOAD MOBILE APP
The Easy Upload mobile app or the Form Upload tool found on the Client Services site can be used to securely send documents to us regarding a specific Life & Health policy or Annuity contract, even if you aren’t a registered contract/policy holder. Simply click on the Start Uploading button. You will need to know the contract/policy number and the owner’s zip code to use this feature.
