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Critical illness claim forms

How to make a claim

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.

Step 1: Complete a claimaint statement.

Download this form and fill it out in Adobe Reader XI or higher - Opens in a new window (not your browser) and save.

Step 2: Ask your doctor to complete a report.

Choose the most appropriate form for your condition and ask your doctor to complete it.

Step 3: Ask your employer or plan sponsor to complete an employer statement.

They should have this form already.

Step 4: Submit your claim.

Once you have these three forms completed, email them to us at

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