Online forms — access online forms by logging into My Account, then fill out the brief online form and you're done; you'll be notified by email when we receive your request.
Printable forms — print your form, complete the appropriate sections, and then mail it to us.
(To open and view the printable forms, you will need Adobe Reader.)
To service your annuity, please use the annuity forms.
For all other products, please choose the appropriate form below.
Printable Claim Forms
- Dental Insurance
- Hospitalization/Cancer Insurance — Oregon
- Hospitalization/Cancer Insurance — All Other States
- Accident Insurance
- Accidental Death
- Long-Term Care and Home Health Care
- Long Term Patient Care Flow Sheet
- Long Term Plan of Care Treatment
- Medicare Supplement Insurance
- Vision Insurance
- Address Change
- Age Correction
- Automatic Bank Withdrawal
- Beneficiary Form
- Billing Statement Replacement
- Duplicate Copy of Insurance Policy
- ID Card Replacement
- Life Ownership Change Request
- Name Change
- HIPAA Authorization
- Add Household Discount to Medicare Supplement — Illinois and Oklahoma
- Add Household Discount to Medicare Supplement — Louisiana
- Add Household Discount to Medicare Supplement — Ohio
- Add Household Discount to Medicare Supplement — All Other States
- Next of Kin