Submit claims online
Find and complete a healthcare, dentalcare, visioncare and life and accidental death and dismemberment claim form.
- Standard claim forms
- Apply for disability income benefits
- Ambassador, CANUS and Welcome Plan claim forms
- Group critical illness claim forms
- Out-of-country claim forms
- Health SolutionsPlus claim forms
- Application and evidence forms
- Prior authorization forms
- Drug dosage increase form
- Direct deposit form
- Brand name drug coverage form
You can submit many of your healthcare claims through GroupNet, our secure online group benefits website. If you need claim forms, sign in to GroupNet to print forms that are pre-filled with your name, address, and plan number.
