Forms – Individuals

Hospitalization for any other disease

• Cancer Policy and Supplements for Hospitalization due to Disease and Intensive Care Claim Form

Intensive Care

• Cancer Policy and Supplements for Hospitalization due to Disease and Intensive Care Claim Form

First Cancer Diagnosis

• First cancer diagnosis policy claim form completed and signed by claimant and primary care physician

First Heart Attack Diagnosis

• Claim form completed and signed by claimant

Hospitalization due to Accident

• Accident Supplements Claim Form

Emergency treatment for fractures, burns, tendon and ligament tears, bruises, mutilations, or dislocations

• Accident Supplements Claim Form

Accidental Dismemberment

• Dismemberment due to Accident Claim Form

Organ Transplant

• Cancer Policy and Supplements for Hospitalization due to Disease and Intensive Care Claim Form

Natural or accidental death of principal insured or any of their dependents, both in life insurance and cancer policies

• Death Claim Form (natural or accidental)
• Authorization to request autopsy and toxicology report (homicide cases)

Assignment of Benefits for Funeral Home Payment in Life or Cancer Policies

• Assignment of Benefits
• Claim Acceptance (Antifraud Act)

Statement on Services and Merchandise – Funeral Pre-Arrangement Policy

• Statement on Services and Merchandise