Need a quick form? Find our frequently used forms here.
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Frequently used forms
- Dental claim form
- Disabled dependent declaration
- Health benefits claim form (includes vision)
- Health Spending Account (HSA) claim form
- Pre-authorization request form
Specialty claim forms
- Accidental dental claim form
- Ambulance/medical transfer claim form
- Assisted care nursing recommendation claim form
- Glucose monitoring special authorization request form
- Hospital claim form
- Orthotics, orthopedic shoes and modifications claim form
- Direct deposit application form
- Pre-authorized debit form (for individuals)
- Provider direct deposit form (for providers only)
- For emergency health claims: Travel Insurance claim form
- For trip cancellation claims: Trip Cancellation Insurance claim form
- For baggage claims: Baggage Benefit claim form
Disability benefit forms
To submit an application for disability benefits, an employee’s statement, employer’s statement AND attending physician’s statement* are required.
*As a temporary measure due to COVID-19, an attending physician’s statement will not be required at the outset of short-term disability claims for flu-like symptoms and a confirmation of illness form may be submitted with the claim application forms (employee statement and employer’s statement).
- Confirmation of illness
- Employee’s statement
- Employer’s statement (including a Job analysis form or a detailed job description)
- Attending physician’s statement (short-term disability – weekly indemnity OR long-term disability)
- Direct deposit authorization form
Learn more about our disability claims appeals process.
Group life forms
Critical illness forms
To submit an application for critical condition benefit, two forms are required: