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Save the forms to your computer. In some cases, you can fill them in directly before printing. Otherwise, print them out and complete them by hand before mailing to the address indicated on each form.

Looking for Critical Illness claims forms?

Group Critical Illness claim forms are illness specific and are not available on our website. Call 1-866-442-3098 and ask to speak with the Group Life Claims department. We will provide you with the appropriate claim forms and answer any questions you may have. If you would like to order more forms, please use the following links:

Extended Health and Dental claim forms

                                        • Migraine Medication Supplemental Supply Request Form 
                                        • Prior Authorization Form - Abstral (fentanyl)
                                        • Prior Authorization form - Anti-obesity 
                                        • Prior Authorization Form - Arixtra (fondaparinux)
                                        • Prior Authorization Form - Botox ® Specialty Drug                                                                
                                        • Prior Authorization Form - Botox ® Chronic Migraine Form  
                                        • Prior Authorization Form - Brilinta (ticagrelor)
                                        • Prior Authorization Form - Cytomel (liothyronine) 
                                        • Prior Authorization Form - Drug
                                        • Prior Authorization Form - Effient (prasugrel)
                                        • Prior Authorization Form - Eliquis (apixaban), Pradexa (dabigatran) 
                                        • Prior Authorization Form - Fampyra®
                                        • Prior Authorization Form - Forteo® 
                                        • Prior Authorization Form - Fragmin (dalteparin), Fraxiparine (nadroparin) (Forte), Innohep (tinzaparin), Lovenox (enoxaparin) (HP) 
                                        • Prior Authorization Form - Growth Hormones 
                                        • Prior Authorization Form - Hepatits C Therapy 
                                        • Prior Authorization Form - Orgaran (danaparoid) 
                                        • Prior Authorization Form - Prolastin-C
                                        • Prior Authorization Form - Repatha 
                                        • Prior Authorization Form - Tecfidera®
                                        • Prior Authorization Form - Valcyte (valganciclovir) 
                                        • Prior Authorization Form - Xarelto (rivaroxaban) 
                                        • Prior Authorization Form - Xolair® 
                                        • Request for Brand Name Drug Coverage  
                                        • Supplementary Dental Accident Report

                                          Disability claim forms

                                          Life and AD&D Claim forms

                                          Administration forms