If you have coverage through your employer or plan sponsor, use these forms to apply for critical illness benefits for you, your spouse, or your child.
Download this form and fill it out in Adobe Reader XI or higher (not your browser) and save.
Choose the most appropriate form for your condition and ask your doctor to complete it.
They should have this form already.
Once you have these three forms completed, email them to us at firstname.lastname@example.org.