Group Claim Forms
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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-compliant Authorization form by selecting your appropriate state. If your state is not listed - Select standard HIPAA Authorization Form.
You also need to review and print our Notice of Information Privacy Practices for your records.
|- Life and AD&D||- TPA Life and AD&D|
|- Waiver||- TPA Waiver|
|- Dismemberment||- TPA Dismemberment|
|- Disability||- Creditor|
|HIPAA-Compliant Authorization Form||Description|
|- Authstd||Standard Form|
|- Authctnd||North Dakota|
|- Authpsychotherapy||Psychotherapy Notes|
|- Authpsychotherapy (CA)||Psychotherapy Notes (CA)|