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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.

 

Download the Alternative Care Claim Form

Cancer Claim Form

If you need to file a claim for a diagnosis of Cancer, download the below Claim Form.

 

Download the Cancer 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.

 

Download the Cancer Screening Claim 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.

 

Download the Chronic Illness Claim Form

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.

 

Download the Continuation Claim Form

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.

 

Download the Heart / Stroke 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.

 

Download the Heart / Stroke Screening Claim 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.

 

Download the Return of Premium Upon Death Claim Form

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.

 

Download the Travel Log

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.

 

Wellness Rider Claim Form

 

Accident Protection Policies

Accident Claim Form

If you’re filing a claim for any of the reasons listed above, download the Accident Claim Form. Specific claims may include, but are not limited to, X-rays, dental treatment, chiropractic care or physical therapy; services provided in a hospital emergency room; or a fracture, burn, dislocation, laceration, or total and irrecoverable loss of eyesight or limbs as a result of an accidental injury.

 

Download the Accident Claim Form

Accidental Disability Claim Form

If you need to file a claim for a disability diagnosis, download the below Claim Form.

 

Download the Accident Disability Claim Form

 

Nursing Home & Home Health Care Policies

Limited Long-Term Care Claim Form

If you need to file a claim for facility confinement or home health care, click the button below to download the Limited Long-Term Care claim form.

 

Download the Limited Long-Term Care Claim Form