Service Forms
TitleForm#DescriptionAvailability
Request for Change of Ownership14001 This PDF form should be used to update owner and/or contingent owner information on a policy.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Beneficiary Designation Form17075 This PDF form should be used to add or modify the designated beneficiary on a policy.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Accident67715 This PDF should be used to submit an accident claim.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Catastrophic Accident57930 This PDF should be used to submit a claim for the catastrophic accident benefit.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Continuing Disability46988 This PDF should be used to submit a continuing disability claim.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Critical Illness65017 This PDF should be used to submit a claim for the critical illness benefit.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Disability64387 This PDF should be used to submit a disability claim.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Group Supplemental Hospital Confinement60316 This PDF should be used to submit a claim under the Group Supplemental Hospital policy offered by your employer, if available where you work.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form and Instructions - Group Short-Term Disability19057 This PDF should be used to submit a claim under the Group Short-Term Disability policy offered by your employer.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Medical Bridge 3000 Doctor's Office Visit Benefit Claim Form69121 This PDF should only be used to submit a claim form for a doctor's office visit if you have a Medical Bridge 3000 policy.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Fraud Warning and State Variations58147 This PDF should be used to review state fraud warnings.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Express Filing of Pregnancy Claim49507 This PDF should be used for the express filing of pregnancy claims. This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Express Filing for Health Screening Benefit Form70067 This PDF should be used for the express filing of health screening claims.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Loss of Life (death) Notification Form Submit Loss of Life Notification online.Complete this form online.This form is not available as a PDF.This form cannot be completed over the phone.
Request For Service05897 Use this PDF form to request changes to personal data, beneficiary, or to exercise policy provisions.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Service Guide for Policyholders43233 This helpful flier provides information on finding the most up-to-date claim forms, submitting a claim and selecting optional services on the claim form. The form also provides helpful tips about the claims process, how the policy works and when to contact the service center.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Universal Claim Form This PDF should be used to submit a claim under cancer, accident, critical illness and hospital confinement policies.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Wellness Claim Form Submit a wellness claim online.Complete this form online.This form is not available as a PDF.This form cannot be completed over the phone.
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Formularios de reclamación
Título#formaDescripciónFormatos
Formulario para la Designación de Beneficiario51578 Este formulario se usa para designar un beneficiario primario o para seleccionar beneficiarios contingentes.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Formulario para la Presentación de una Reclamación51164 Este formulario se puede usar para procesar su reclamación.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Formulario para Solicitar Servicio18397 Use este formulario para cambiar su dirección u otra información personal, cambiar su beneficiario o para efectuar otros cambios relacionados con su póliza.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
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