Forms

Find general and claims forms for your needs.

Select from the options below

General Forms Claims Forms

General Forms

Appeals Form

English Chinese German español portuguese

Application for Individual Coverage

English

Complaints Form - AXA XL

English

Complaints Form - AXIS

English

Complaints Form - GBG Insurance Ltd.

English

Complaints Form - Sompo International

English

Life Insurance Beneficiary Form

English Spanish

Life Insurance Beneficiary Form (Groups)

English

Maternity Questionnaire

English Spanish Chinese Portuguese

Maternity Questionnaire - TieCare

English

Medical Accident Questionnaire

English Spanish Chinese Portuguese

Medical Release Form

English Chinese español Portuguese

Preauthorization

English Spanish French Chinese Japanese Portuguese

Student Insurance Verification Form

English

Claims Forms

Dental Claim Form

English French

Disability Claim Form

English Spanish

Life Claim Form

English Spanish

Medical, Wellness & Vision Claim Form

English Spanish French Chinese Japanese Portuguese

Safe Travels Medical Claim Form

English

Safe Travels Trip Claim Form

English

Student Medical Claim Form

English

Student Medical Claim Form - Short Term

English

Travel Claim Form

English Spanish Portuguese German