or call 1-866-488-3266

Forms

Employers Forms

Beneficiary Forms & Resources

Beneficiary Form (available online on My Health Plan by visiting the Forms page under Resources & Tools)
Beneficiary Designation Form (PDF version)

Beneficiary's Checklist (Important Reminders for When a Loved One Dies)

Claim Forms

Accident
Death 
Death (individual policyholders only)
Individual and Small Group Accident, Critical Illness and Hospital Indemnity
Large Group Accident and Critical Illness
Long-term Disability
Multi-claim Form (short-term disability, waiver of premium and accelerated death benefit)
Wellness Benefit

Group Applications

Life and Disability
COSE
MRACC
TRCC

Miscellaneous

Have Questions or Ready to Enroll?

Call us at 866.925.2542, or contact your sales representative or broker.