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Individual Forms

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When downloading a claim form, you must also submit an Authorization for Release of Medical Records.
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FormatForm IDDescription
CL10YT 907 Rev 409 Death Claim Form (10 Year Term Life)
CLADB 809 Accelerated Death Benefit Claim Form
CLAP2 1207 CARE, Accident Guard, & Accident Elite Claim Form
CLAP 809 Accident Plus Claim Form
CLAPPTAUTHREP 1012 Appointment of Authorized Representative
CLCSD 809 Cancer and Specified Diseases Claim Form (CancerCare Elite, CancerCare Series, ICU, Quadriplegia or Lou Gherig’s Disease)
CLDBB 907 Rev 409 Doctor Bill Benefit Claim Form
CLDI 907 Rev 409 VLTD & VSTD Claim Form (School employees only)
CLDIUPDATE 610 Disability Update Form for Short Term Disability
off line CLGAP 704 Rev 409 GAPCARE Claim Form
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