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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
Bank forms
- Direct deposit application form
- Pre-authorized debit form (for individuals)
- Provider direct deposit form (for providers only)
Travel forms
- 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.
- 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 appeals process.
Group life forms
Learn more about our appeals process.
Critical illness forms
To submit an application for critical condition benefit, two forms are required:
Learn more about our appeals process.