Compass Accident Insurance Claims

You may be eligible to receive an Accident benefit and/or a Wellness benefit under your Accident Insurance certificate. Please review your certificate and riders for the eligibility requirements to receive benefits.

To submit a Compass Accident Insurance Claim:

Please print the Accident Insurance Claim form below. The Consumer Privacy Notice is attached.

Note: Please contact your Employer to determine whether the Compass Accident Claim – Employer form is required.

Submit the completed and signed form(s) to the address shown at the top of the form, along with any other required information such as itemized bill(s) or Explanation of Benefits (EOB).

To submit a Wellness Benefit Rider Claim:

Please print the Accident Insurance Wellness Benefit Rider Claim form below. The Consumer Privacy Notice is attached.

Submit the completed and signed form to the address shown at the top of the form, along with any other required information such as itemized bill(s) or Explanation of Benefits (EOB).

Form NameForm Number

Accident Insurance Claim  Employee (with Consumer Privacy Notice 47316c attached) for certificates issued by ReliaStar Life Insurance Company

 165758 (01/14/13)

Compass Accident Claim  - Employer (with Consumer Privacy Notice 47316c attached) for certificates issued by ReliaStar Life Insurance Company

165759 (11/11/13)

Accident Insurance Wellness Benefit Rider Claim Employee (with Consumer Privacy Notice 47316c attached) for certificates issued by ReliaStar Life Insurance Company

165760 (2/7/14)