Claim Forms

• Individual Request for Death Benefit Advance View & Download
• Group Request for Death Benefit Advance View & Download
• Statement of Claim for Long Term Care View & Download
• Request for Death Benefit Advance for GUACICA Rider (no more than 100%) View & Download
• Request for Death Benefit Advance for GUACICA Rider (no more than 50%) View & Download
• Statement of Claim for Hospital Indemnity (SHOP/GIM) View & Download
• Statement of Claim for Life View & Download
• Outpatient Physician's Treatment Benefit Claim Form View & Download
• Wellness Benefit Claim Form View & Download
• Appeal Claim Form View & Download
• Statement of Claim for Disability View & Download
• Statement of Claim for Critical Illness View & Download
• Statement of Claim for Cancer View & Download
• Statement of Claim for Heart Stroke View & Download
• Beneficiary Information and Instructions for Life and Accidental Death Policies View & Download
• Statement of Claim for Accident View & Download
• Statement of Claim for Waiver of Premium View & Download
• Statement of Claim for Maternity Disability View & Download

Claim Related Forms

• Physician's Certification View & Download
• Losing a Loved One View & Download
• Physician's Certification GUACICA Rider View & Download
• Attending Physician's Statement View & Download
• Authorization to Release Information to AHL View & Download
• Assignment of Benefits Form View & Download
• Employer's Statement View & Download

Service Request Forms

• Additional Addressee Designation/Change Form View & Download
• Child Term Rider Conversion Form View & Download
• Direct Deposit Authorization Form View & Download
• Automatic Bank Draft Request/Changes View & Download
• Automatic Bank Draft Cancellation Request View & Download
• Health Policy Change & Service Request View & Download
• Life Policy Change & Service Request View & Download
• Customer Agreement View & Download
• Change of Beneficiary Request View & Download
• Beneficiary Information and Instructions for Life and Accidental Death Policies View & Download
• General Authorization to Disclose Policy Information and Protected Health Information - HIPAA View & Download