Supplemental Cancer, Heart Attack and Stroke Policies
Alternative Care Claim Form
To file a claim for alternative care benefits, such as therapeutic massage, complete and submit the Alternative Care Benefit Claim Form. Claimants must be 18 years or older.
Cancer Claim Form
If you need to file a claim for a diagnosis of Cancer, download the below Claim Form.
Cancer Screening Claim Form
To file a claim for a healthcare screening, such as a biopsy or CT scan, complete and submit only the Screening Claim Form. Claimants must be 18 years or older. Do not include receipts, statements, test results, itemized bills or other claim forms upon submission of this form.
Chronic Illness Claim Form
If you need to file a claim for a diagnosis of chronic illness or an organ transplant, download the Claim Form. Chronic illness diagnosis covered by this benefit include coma, permanent paralysis, Alzheimer’s Disease and end-stage renal failure.
Continuation Claim Form
This claim form is designated for continuing a claim that has previously been submitted to us including Cancer, Heart Attack, Stroke, Chronic Illness, and Accident.
Heart / Stroke Claim Form
If you need to file a claim for diagnosis of Heart Attack (excludes cardiac arrest), Artery Bypass Surgery, Coronary Angioplasty, or Stroke, download the below Claim Form.
Heart / Stroke Screening Claim Form
To file a claim for a healthcare screening, such as an Angiogram, Carotid Ultrasound, or CT scan, complete and submit the Heart Screening Claim Form. Claimants must be 18 years or older. Do not include receipts, statements, test results, itemized bills or other claim forms upon submission of this form.
Return of Premium (ROP) Upon Death Claim Form
This claim form is applicable if you purchased the Return of Premium option for your policy.
Travel Log
To submit your dates of travel and milage, please download the below form. Travel is only payable when the claimant is traveling at least 50 miles one way from their residence to a facility to receive treatment for a condition covered by the policy.
Wellness Rider Claim Form
Use the Wellness Rider Claim Form to file a claim for wellness benefits only if you purchased the wellness rider option for your policy. Do not include receipts, statements, test results, itemized bills or other claim forms upon submission of this form.