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SEE FORMS RELATED TO
Upload Long-Term, Short-Term & Home Health Care claim documents.
Looking for mailing addresses to send claim or policy service forms ?
Enter the following information for primary insured or policy owner
Enter a valid policy number.
Enter the first and last name of the owner or primary insured.
Last 4 SSN
Enter the last 4 digits of your Social Security Number.
You may continue without a policy number; however, you will need to print and mail or fax back the signed, completed form along with any required supporting documents to our home office.
Continue without a policy # by selecting the company and policy type.
Please contact customer service at (800) 621-3724 (800) 525-7662 for assistance.