If you have coverage through your employer or plan sponsor, use this form if you are a beneficiary or estate representative making a life insurance claim.
To make a claim:
Download the statement and print it or fill it out in Adobe Reader XI or higher (not your browser) and save.
In some cases, you will need to ask the attending physician for a certificate of death. Download this form, and ask them to fill it out.
Once you’ve filled out and completed the applicable forms, send them to us at email@example.com.