In this section you will find the forms and documents you may need to manage your LTD, Life and Accidental Death and Dismemberment coverage.

Application Forms

• Application Checklist
• Benefits Summary
• Evidence of Insurability Form
• Group Benefit Application
• Information Release Authorization
• Pre-authorized Debit Agreement

Disability Claim Forms

• Critical Illness -  Claimant's Statement
• Employee and Physicians’ Statements – LTD

Contact us before completing any disability claim forms.

Life Forms

• Accidental Dismemberment or Specific Loss Claim Form
• Group Life Benefits - Attending Physician's Certificate of Death
• Group Life Benefits - Certificate of Attending Physician Dismemberment or Loss

• Group Life Claimant Statement

Contact us before completing any life claim forms.

 Utility Forms

• Application to Terminate or Maintain Insurance Coverage
• Application to Terminate LTD Coverage
• Beneficiary/Spousal/Contingent Designation Form
• Coverage Reduction Form
• Dependent Information Form
• LTD Option Change Form
• Smoker/Non-Smoker Change Form