Need to file a Voluntary Benefits (Group Policy) Claim?


ManhattanLife
VB Claims Department
PO Box 926169
Houston, TX  77292

 

Fax: 1-502-405-7107
Phone: 1-855-448-6982
Email: VBClaimsSubmissions@manhattanlife.com

 

Please choose the appropriate form below.

 CLAIM FORM PRODUCT 
VB Accident Claim Form Accident
VB Group Affordable Choice Claim Form Hospital Indemnity
VB Assignment of Benefits Assignment of Benefits
VB Health Screening Benefit Claim Form  Accident, Critical Illness and Hospital Indemnity 
VB Lifestyle Reward Claim Form Accident, Critical Illness and Hospital Indemnity 
VB Cancer Claim Form Cancer
VB HealthCare Plus and Cancer Wellness Claim Form Cancer, HealthCare Plus 
VB Critical Illness Claim Form Critical Illness
VB Disabled Dependent Certification Form All Products
VB Disability Maternity Claim Form Disability
VB Disability Initial Claim Form Disability
VB Disability Continuation Claim Form Disability
VB Hospital Indemnity/Supplemental Health Claim Form  Hospital Indemnity /Supplemental Health
VB Hospital Indemnity/Supplemental Health Claim Form With Tiered Benefits Hospital Indemnity/Supplemental Health
VB Individual Accident Claim Form Individual Accident
VB Facility Care Accelerated Living Benefit Term Life/Whole Life

VB GAP Claim Form

 Hospital Indemnity/Supplemental Health
VB Life Claim Form Term Life/Whole Life
VB Accelerated Benefit Claim Form Term Life/Whole Life
VB Waiver of Premium Initial Claim Form Waiver of Premium
VB Waiver of Premium Continuation Claim Form Waiver of Premium