Waiver of Premium Claims

Not all policies have this option -- check the policy or certificate. There may also be eligibility limits for this benefit (i.e. the insured usually has to be under age 60 to apply). Remember to complete any applicable Administrator or Employer section(s) before distributing forms to insureds.

To submit a claim, you need to distribute the following forms to the insured:

  • Claim form
  • Attending Physician's Statement of Disability
  • Authorization for Release of Health-Related Information
  • Consumer Privacy Notice
Claim form for Association Group Term Life and Individual YRTForm Number

Claim form for policies issued in New York

126268 (rev 07/11)

Claim form for policies issued in ALL OTHER STATES

44157i (115700)(rev 12/12)

Claim form for Individual TriTermForm Number

Claim form

428571l (115591)(rev 12/12)

Attending Physician's Statement of Disability FOR ALL CLAIMSForm Number

Attending Physician's Statement of Disability

44540i (115754)(rev 12/12)

Authorization for Release of Health-Related Information FOR ALL CLAIMSForm Number

Authorization for Release of Health-Related Information

127182 (rev 02/13)

Consumer Privacy Notice FOR ALL CLAIMSForm Number

Consumer Privacy Notice

47316c (116249)

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