Group Critical Illness Claim Forms
These forms are for group plan members with Group Critical Illness or Group Critical Illness Plus coverage. A Claimant’s Statement and a Confidential Physician’s Report must be completed for each claim.
These documents are in PDF format. To view and print them, you need Adobe Acrobat Reader Version 4.0 or higher, which you can download, at no cost, from the Adobe website.
Confidential Physician's Report
Choose the Confidential Physician's Report form for the appropriate illness: