Downloadable Forms
Download the forms you need.
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- Life, Disability, Vision and Supplemental Health Enrollment and Change Form — You may use this form to enroll in any or all of our group ancillary products.
- Beneficiary Designation — Use for designating beneficiaries for life and disability benefits.
- Beneficiary Designation – Spanish — Use for designating beneficiaries for life and disability benefits.
- Evidence of Insurability — Medical Evidence of Insurability for coverage changes.
- Evidence of Insurability – Spanish — Medical Evidence of Insurability for coverage changes.
- Portability Application – Life — Use to continue Life coverage due to termination.
- Portability Application – Accident — Use to continue Accident coverage due to termination.
- Portability Application – Hospital Indemnity — Use to continue Hospital Indemnity coverage due to termination.
- Portability Application – Critical Illness — Use to continue Critical Illness coverage due to termination.
- Portability Application – Spanish — Use to continue Life coverage due to termination.
- Application to Convert Group Life Insurance — Conversion allows Employees and their covered dependents to convert some of their Basic Life and/or Voluntary Life insurance to an individual whole life policy.
Claim Forms
NEW: Submit Disability Claims with our new online form.
- Accidental Death & Dismemberment Claim Form
- Accelerated Death Benefit Claim Form
- Critical Illness Claim Form
- Critical Illness Claim Form – Spanish
- Supplemental Health Wellness Benefit Claim Form
- Supplemental Health Wellness Benefit Claim Form - Spanish
- Accident Claim Form
- Accident Claim Form – Spanish
- Hospital Indemnity Claim Form
- Life Insurance Claim Form
- Life Insurance Claim Form - Spanish
- Long-Term Disability Claim Form
- Long-Term Disability Claim Form - Spanish
- Short-Term Disability Claim Form
- Short-Term Disability Claim Form - Spanish
- Vision Claim Form
- Waiver of Premium Claim Form
- Long-Term Disability Conversion Kit