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

Pathology report

School

School Claim Form
Itemized doctor bill
Itemized hospital bill

Wellness Benefit

Wellness Claim Form
Itemized statement of charges and procedure performed.