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, either for you 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 firstname.lastname@example.org.