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 Insurance Arizona
- Hospitalization Insurance Arkansas
- Hospitalization Insurance California
- Hospitalization Insurance Colorado
- Hospitalization Insurance Maryland
- Hospitalization Insurance Oregon
- Hospitalization Insurance All Other States
- Accidental Death
- Long-Term Care and Home Health Care
- Medicare Supplement Insurance
- Address Change
- Age Correction
- Automatic Bank Withdrawal
- Beneficiary Change
- Billing Statement Replacement
- Duplicate Copy of Insurance Policy
- ID Card Replacement
- Life Ownership Change Request
- Name Change
- HIPAA Authorization