Claim Forms

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Claim Form C101
Use claim form C101 for the following products:
  > Accident
  > Cancer
  > Cancer - Dread Disease
  > Cancer - Wellness Benefit
  > Disability - Accidental Death & Dismemberment Rider
  > Disability - Emergency Accident Rider
  > Disability - Family Accident Benefit Rider
  > Heart Attack/Stroke
  > Hospital Indemnity – Accidental Death & Dismemberment Rider
  > Hospital Indemnity – Emergency Accident Benefit
  > Hospital Indemnity – Hospital Confinement & Annual First Occurrence Benefits
  > Hospital Indemnity – Outpatient Sickness Benefit
  > Hospital Indemnity – Surgery and Anesthesia Benefit
  > Hospital Indemnity – Wellness Benefit/Diagnostic Testing
  > Intensive Care
  > MedLink

Claim Form C103
Use claim form C103 for the following products:
  > Disability