Download the forms you need to efficiently administer your ancillary products.
Having trouble downloading or viewing forms? Get help here.
- Life, Disability, Accident, Critical Illness, Vision and Dental Enrollment and Change Form — You may use this form to enroll in any or all of our group ancillary products.
- Evidence of Insurability — Medical Evidence of Insurability for coverage changes.
- Portability Application – Life — Use to continue Life coverage due to terminate.
- Portability Application – Accident — Use to continue Accident coverage due to terminate.
- Portability Application – Critical Illness — Use to continue Critical Illness coverage due to terminate.
- 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.
- Beneficiary Designation — Use for designating beneficiaries for life and disability benefits.
- Beneficiary Designation - Spanish — Use for designating beneficiaries for life and disability benefits.
- Benefits Manager Registration — Use to register for secure online group administration.
- Group Application Packet — Contains all forms needed to apply for coverage. Must be submitted with the Producer Transmittal form.
- Producer Transmittal — This form is to be completed by the producer regarding coverage. Must be submitted with the Group Application.
- Third Party Administrator Questionnaire — Complete this form if a third party will be administering your plan.
- FICA Tax/W2 Agreement — This form is to be completed by the employer.
- Broker Authorization for Group Changes — Employers can authorize the broker of record to complete group changes on their behalf.
- Policyholder Vendor Authorization/Change Form — When an eligibility or medical integration file is established with a Policyholder’s Vendor, this authorization form must be completed.
- Accidental Death & Dismemberment Claim Form
- Accelerated Death Benefit Claim Form
- Critical Illness Claim Form
- Critical Illness Wellness Benefit Claim Form
- Accident/Critical Illness Wellness Benefit Claim Form
- Accident 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