Life and Health Claims
Insuring your world and providing prompt service and assistance in your time of
need is our number one goal.
For your convenience, our web site offers you access to the claim forms you need
for filing a death claim, health/disability claim, wellness benefit claim, or school
accident claim. Each form contains instructions for filing the claim. We welcome
the opportunity to be of service to you and invite you to call us at 1-800-798-2317
if you need assistance or have any questions.
The forms and documentation needed for filing a claim are listed below:
Critical Illness
- Health Claim Form
- HIPPA Authorization Form – complete only if your policy is less than two years old
- If the result of cancer, attach a copy of the pathology report
Death
- Death Claim Form
- Death certificate (Must be certified if the policy is $5,000 or more)
- The policy
If you are not the named beneficiary you will also need to submit:
- Statement of Next of Kin
- Proof of death for the named beneficiary (this may be a copy of death certificate,
funeral program or obituary notice)
- For funeral policies you will need to submit a copy of the funeral contract
Disability
- Health Claim Form
- Employer’s Statement
- HIPPA Authorization Form (complete only if your policy is less than one year old)
Health
- Health Claim Form – standardized claim forms are accepted from the physician
- HIPPA Authorization Form – complete only if your policy is less than two years old
- Itemized physicians charges
- Claims under cancer expense policies must be
accompanied by a pathology report
Lump Sum Cancer
School
- School Claim Form
- Itemized doctor bill
- Itemized hospital bill
Wellness Benefit
- Wellness Claim Form
- Itemized statement of charges and procedure performed.