April 25, 2022; ASSURITYLIFE INSURANCE COMPANY Post Office Box 82533, Lincoln, NE 68501-2533 (800) 869-0355, Ext. Transamerica Wellness Instructions Illinois Mutual Accident Claim Form. NOTE: Assurity can accept wellness claims over the phone. Allows you to focus on recovery from a serious illness without the financial stresses of day-to-day living. This information does not replace any policy provisions or reports, and is Make a disability income claim Download a disability claim package Please contact Assuritys claim department at (800) 869-0355, extension 4484 with any questions or to request an authorization form. You may fax your claim to us at 1-800-430-4188. Complete and submit the following form. Assurity offers a wide range of insurance products, designed to financially protect and support you and your family. Male Female Policyowners Assurity Wellness claims can be filed 1 of 3 ways: Phone(Recommended): Assuritys Claims at Department at (800) 8690355, Ext. Your Aflac wellness claim pays you money for staying on top of your health by getting yearly checkups and medical screenings such as physicals, dental exams and eye tests.

Fax: 1-402-437-4592 or toll free fax 1-800-869-0368. Click on Secure Channel on the Guardian Anytime home page. INSTRUCTIONS FOR FILING WELLNESS CLAIMS To avoid delays in processing please fill out the sections which apply to your specific claim. Claim forms should be emailed, faxed, or mailed to: Jade Schweighart. ASSURITY LIFE INSURANCE COMPANY Post Office Box 82533, Lincoln, NE 68501-2533 (800) 869-0355, Ext. Click on the fillable fields and add the required information.

Please be assured that your claim will receive our prompt attention. 4484. 01-013-02255. File a claim. Proof of Claim may be required within 12 months of the time of loss. Address Street address City State Zip code +4 Please contact Assuritys claim department at (800)869-0355, extension 4484 with any questions. Claims can be faxed to (800) 869-0368 or mailed to Assurity at the address on the top of this form. Please note: If your policy includes the Assurant Employee Benefits name or logo, or is underwritten by Union Security Insurance Company or Union Security Life Insurance Company of NY; please click here to access your forms. 92-500-05055 When Assurity receives notice of a claim, the necessary proof of loss forms will be sent to the insured including the following: Claimants Statement - Form No. Include your policy number(s). Submit all of the requested boxes (they are yellow-colored). Wellness / Cancer Screening Claim Statement Assurant Employee Benefits is the brand name for insurance products underwritten by Union Security Insurance Company. Accident; Critical Illness; Voluntary Term Life; Hospital Indemnity; Schedule an Appointment; Assuritys disability policies have elimination periods of 30, 60, 90, 180, or 365 days, subject to a benefit period. Most Aflac accident, hospital indemnity and cancer insurance policies have a wellness benefit to pay you for staying on top of your health. NOTE: Assurity can accept wellness claims over the phone. Claim forms may be returned to Assurity by the methods described above. Box 19040 Kalamazoo, MI 49019-0040 Phone: 269-343-2611 Fax: 269-349-3275 www.groupmarketingservices.com Group Life Insurance Claim Form Beneficiary Statement To avoid unnecessary delays, be sure all parts of the Claim Form are completed accordingly.

Before calling to fi le a wellness claim, please compile the following information as it pertains to your wellness claim: the date of service, the name of the procedure performed, the amount charged and the name and contact information for your medical provider. PLEASE REFER TO OUR: PRIVACY POLICYPRIVACY POLICY 4484 Fax (800) 869-0368 WELLNESS SCREENING Policyowners Name First, Middle, Last Policy no. assurant claim form for benefits, those exposures whose price, such as well. 2022 Assurity Accident Summary; 2022 Assurity How to File a Claim; 2022 Assurity Wellness Claims Form; Core Benefits. Illinois Mutual Wellness Claim Form. Include your policy number(s). 4484. Employers Statement - Form No. 4484 Fax (800) 869-0368 Cancer Screening Claim Form CLAIMANT STATEMENT Policyowners Name First, Middle, Last Policy no. Online(Please note they have very detailed security questions and the processing time is longer) Customer Service Center on www.assurity.com. Attending Physicians Statement - Form No. Mail: United Schools Associates, Inc. & Assurity Claims Department. Download a wellness benefit claim form, Assurity Wellness / Screening Benefits provide a benefit for certain wellness-type exams and procedures. In which state does the person making the claim live? Before calling to fi le a wellness claim, please compile the following information as it pertains to your wellness exam: the date of service, procedures and/or tests performed, the amount charged, and the name and contact information for your medical provider. A pathology report and any additional medical records would also be helpful in processing your claim. ( ) Social Security no. Once you have the required information, you can file your claim by calling Assuritys claims department at (800) 869-0355, Ext. FRAUD NOTICES Unless specific state language is provided below for your state of residence, the following general fraud notice applies. 01-014-02255. Filing a Claim.

Medical; Dental; Vision; Flexible Spending Accounts; Basic Life and AD&D; Voluntary Benefits. If you are unsure about which form to use, please contact your HR department or benefits administrator.

Sample cover personal wellness plans offer a claim forms are well as assurant health insurer liability balances. In filing a claim with Assurity Life Insurance Company, the necessary proof of loss forms are as follows: In filing a claim with Assurity Life Insurance Company of New York, the necessary proof of loss forms are as follows: Attending Physicians Statement - Form No. 01-014-02255 NY 4484. PO Box 82533 Lincoln, NE 68501-2533. Notice, including the insureds name and policy number, may be sent to Assurity by one of the following: Assurity Life Insurance Company of New York Administrative Office When Assurity receives notice of claim, the necessary proof loss forms will be sent. Notice may also be provided by submitting necessary claims forms. Customer Center on assurity.com, in the policy owners MyAssurity secure account, or by contacting Assuritys Claims Department at 800-869-0355 Ext. They define disability as not being able to work in your current occupation for two years, then not in any occupation after that. Email: [email protected] If the claim is for a spouse or a child 18 years of age or older, the claim will require submission by fax, email or mail. Make a disability income claim. To obtain your policy number(s) call 1-800-348-4489. After receiving Notice of Claim, Assurity will send the policyowner the forms or information necessary for filing Proof of Loss depending on the coverage, as detailed below. Assurity Wellness Benefit Instructions & Form. You may .

Select the Get form button to open it and move to editing. Allows your loved ones to remain financially secure after you die. Complete Assurity Cancer Wellness - Mark III Brokerage online with US Legal Forms. I have read and accepted the terms and conditions in the Assurity Privacy Policy. An authorization to release medical information may be needed. Filing a Claim. [email protected] 01-012-02255.

Client Services/Claims Specialist. 307-684-0616 Fax. Download a wellness benefit claim form, Assurity Wellness / Screening Benefits provide a benefit for certain wellness-type exams and procedures.

Youll need to provide your carrier, your device make and model, a description of what happened, a billing and shipping address, and a method of payment for the deductible. ASSURITY LIFE INSURANCE COMPANY Post Office Box 82533, Lincoln, NE 68501-2533 (402) 476-6500 (866) 289-7337 FAX (877) 864-6630. Download a wellness benefit claim form Claims Forms For Assurity. 01-014-02255. assurity wellness claim. TO BE COMPLETED BY BENEFICIARY When reporting a claim, please have all the pertinent information available, such as the date, time, location of the loss, and names and contact information of the parties involved.

1-866-541-5794.

The values displayed are subject to change, the information is for summary purposes only. Policyholders may also submit claims for wellness benefits online through their myassurity.com account by following these simple steps: 1. Select "Claims" from the menu bar and choose t Generally speaking, the following is applicable to COVID-19 related coverage for the following types of insurance: Disability Income Insurance Assurity Wellness Claim Form (2) Authorization Form. faxyour claim to us at -866-427. 307-684-0789 Office. Their benefit periods can be 1, 2, 5, or 10 years, or can payout at age 65 or 67. 4484 Fax (800) 869-0368 CLAIMANT STATEMENT First, Middle, Last Policyowner. Authorization Statement - Form No. 01-012-02255. Address Street address City State Zip code +4 Phone no. 4484. Assurity Wellness Claim Form. You can also contact your local agent or report the claim online. Access the Claims drop-down menu and select Submit a Wellness Claim 2. Paper(Not Recommended, takes longer) Form included below and should be emailed, faxed, or Hello, Paperless Claims Online wellness claim submission now available Submit your Wellness Claim online Policyholders may now submit claims for wellness benefits online Assurity is a marketing name for the mutual holding company Assurity Group, Inc. and its subsidiaries. Customer Center on assurity.com, in the policy owners MyAssurity secure account, or by contacting Assuritys Claims Department at 800-869-0355 Ext. Disability Income claim forms listed above should be completed by your spouse, your spouses physician and your spouses employer. Worksite Group HEALTH ENROLLMENT FORM PLEASE PRINT WITH BLACK INK Lincoln Wellness Claim Form. Critical Illness Wellness Benefit Claim Form Send to Guardian Life Insurance, Critical Illness Claims, PO Box 14334 Lexington KY 40512 Customer Service: 1-800-268-2525 Fax: (610) 807-2999 Documents can be returned electronically at www.GuardianAnytime.com. Download a disability claim package. In filing a claim with Assurity Life Insurance Company, the necessary proof of loss forms are as follows: Claimants Statement - Form No. The required forms listed below can be accessed in the Customer Service Center on www.assurity.com or by contacting Assuritys Claims Department at (800) 869-0355, Ext. ASSURITY LIFE INSURANCE COMPANY Cancer Screening Claim Form Post Office Box 82533, Lincoln, NE 68501-2533 (800) 869-0355, Ext.

ASSURITY LIFE INSURANCE COMPANY Post Office Box 82533, Lincoln, NE 68501-2533 (800) 869-0355, Ext. INSTRUCTIONS FOR FILING WELLNESS CLAIMS To avoid delays in processing please fill out the sections which apply to your specific claim. If youre involved in an auto accident, contact our claims office at 800.242.7666. 01-013-02255. Claim forms should be emailed, faxed, or mailed to: Jade Schweighart. Proof of Claim may be required within 12 months of the time of loss. To begin the claim process or request the proper forms, contact the claims contact center: Email: [email protected] Attending Physicians Statement - Form No. File your claim online.

be necessary to determine benefit eligibility and may require Assurity to order medical records. How to submit your Assurity claim Our simple 4-step process Go to the Customer Center tab on Assurity.com Print the package of instructions and materials Select your benefit type and state under Customer Service Forms Complete documents 4484. Execute Assurity Cancer Wellness - Mark III Employee Benefits in just a couple of moments by simply following the instructions listed below: Select the document template you require from the collection of legal form samples. After you submit the device claim, you should receive an email with shipping and tracking information for your replacement device. Proof of Claim may be required within 12 months of the time of loss. If your contract includes benefits not described in this document or you have questions, please contact Assuritys Claims Department at (800) 869-0355, Ext. Assurant Employee Benefits 300 Southborough Drive, Suite 200 South Portland, ME Assurity Life Insurance Company P.O. If forms are emailed or faxed, please do not mail the original. Were here to help you. Log into MyAssurity to check your policy information, pay a bill or submit a health insurance or wellness claim electronically. Can't find what you need? Find a form. Employers Statement - Form No. Your spouse must also sign the Authorization form. Critical Illness Claim Form (IN) Critical Illness Claim Form (MI) Critical Illness Claim Form (MT) Critical Illness Assurity encourages policyowners questioning whether COVID-19 related benefits are available to either access claim forms by visiting Assurity.com or MyAssurity.com, or call us at 800-869-0355 for assistance. To obtain your policy number(s) call . Filing a Claim. If the claim is for a spouse or a child 18 years of age or older, the claim will require submission by fax, email or mail. 4484. Accident Claim Form. Download a wellness benefit claim form, Assurity Wellness / Screening Benefits provide a benefit for certain wellness-type exams and procedures.