Forms All forms are in Adobe® Acrobat® format. Click on the form you need and you should see the form appear in a new window. Print, complete and sign the form before submitting it to your employer or Boston Mutual Life Insurance Company.

GROUP CLAIM FORMS: If you are an employer who has group coverage for life and/or disability, or a third party administrator who administers group benefits, please select from the following list of forms. In addition to downloading your claim kit, you MUST also download the appropriate HIPAA form by selecting your appropriate state. If your state is not listed - Select standard Hipaa Form. You also need to review and print our Notice of Information Privacy Practices for your records. Life and AD&D Waiver Dismemberment Disability TPA Life and AD&D TPA Waiver TPA Dismemberment Creditor

Form Name Description HIPAA Authorization Authstd STANDARD FORM Authcactnd CALIFORNIA Authcactnd CONNECTICUT Authme MAINE Authmn MINNESOTA Authcactnd NORTH DAKOTA Authvt VERMONT Authwi WISCONSIN Authpsychotherapy PSYCHOTHERAPY NOTES