Make a Claim
Platinum’s customer service specialists are knowledgeable licensed insurance agents. They can answer questions and provide step-by-step assistance to start your claim with the insurance carrier. All claims are administered by the insurance carrier, and Platinum’s customer service specialists are here to assist you through the process.
Customer Service
M-TH 8 am – 5 pm EST
FRI 8 am – 1pm EST
Phone: 1-855-774-4495
Fax: 1-813-386-4425
Email: Customerservice@pltnm.com
Platinum Supplemental Insurance
PO Box 1404
Rome, GA 30162
Download Claim Forms
Cancer, Heart Attack and Chronic Illness Supplemental Policies
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.
Heart and 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 and 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.
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.
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.
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.
Accidental Disability Claim Form
If you need to file a claim for a disability diagnosis, download the below Claim Form.
Hospitalization Benefit Policies
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.
Wellness Rider Benefit
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.
Wellness Benefit Claim Form
Use the Wellness Benefit 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.
Screening Benefit Claim Form
To file a claim for a healthcare screening, 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.
Return of Premium Upon Death Benefit
Return of Premium (ROP) Upon Death Claim Form
This claim form is applicable if you purchased the Return of Premium option for your policy.