Please select one of the following claim forms:

• Death Claim Form
• Convalescent Care Benefit Form
• Accelerated Death Benefit Form (For Terminal Illness)
• Waiver of Premium Initial Claim Form
• Education and Training Evaluation
• Functional Capacity Evaluation
• Continuance Waiver of Premium Claim Form
• Permanent Waiver of Premium Claim Form

Please complete the appropriate claim form, sign and mail it to the address indicated on the form. If faxing your claim form to us, we ask that the original be sent via mail to assure timely service of your claim. Our fax number appears on the bottom of our claim forms for your convenience.