Life Happened and now I have a Claim!

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  Accident Claim Form
• Guaranteed Trust Life (GTL) Accident Claim Forms
  
  • Accidental Death Claim Form
  • Accidental Dismemberment & Loss of Sight Claim Form
  • Accident Medical Expense Claim Form
• Assurant Accident Claim Form (CO)
• Accident Claim that occured before 6/1/18,
  & you had Catlin at time of claim

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  ER / Urgent Care Claim Form
• 
  Dr Visit, Labs & X-rays Claim Form
• ER Claim that occured before 6/1/18,
  & you had Catlin at time of claim

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  Critical Illness Claim Form
• 
  Windsor Critical Illness Claim Form
• Critical Illness Claim that occured before 6/1/18,
  & you had Catlin at time of claim

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• Federal Insurance Company, a member insurer of the Chubb Group of Companies
  
  
  Gap HCI Claim Form

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  Group Term Life Claim Form
• Group Term Life
  Beneficiary Change Form

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  STM PLUS PLAN
  Short Term Medical Claim Form
• 
  STM (C&F) PLAN
  Short Term Medical Claim Form

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  Dental Claim Form

Look at your ID Card & Member Guide for the correct carrier to download. Unsure which claim form to use?
Call us at 866.438.4274 and we can help you.

Click on Link Below to Download Form

• 
  Vision Claim Form

Note: There are no claim forms to complete when you visit a VSP participating doctor.