Claim Forms
- Accident Claim Fax Cover Sheet
- Critical Illness Claim Form
- Disability Claim Form
- Medical Illness Claim Form
- Medical Accident Claim Form (In English) / (en Español)
- Premium Waiver Form
- Prescription Drug Claim Form
- Wellness Claim Form
Home Health Care (HHC) Forms
- HHC Standard Benefits Claim Form by ManhattanLife
- HHC Standard Benefits Claim Form by Standard Life
- HHC Extra Benefits Claim Form by ManhattanLife
- HHC Extra Benefits Claim Form by Standard Life
- HHC Critical Accident Claim Form by ManhattanLife
- HHC Critical Accident Claim Form by Standard Life
Short Term Care (STC) Forms
Other Forms
- Affidavit of Lost Policy Form
- Bank Draft Authorization Form (In English) / (en Español)
- Beneficiary Change Form
- Health Policy Cancellation Form
- HIPAA Form (release PHI from provider) / Other HIPAA Form (release PHI to agent, family member, other 3rd party)
- Persistency Bonus/Return of Premium Surrender
- Policy Service Form
EASY UPLOAD MOBILE APP
The Easy Upload mobile app or the Form Upload tool found on the Client Services site can be used to securely send documents to us regarding a specific Life & Health policy or Annuity contract, even if you aren’t a registered contract/policy holder. Simply click on the Start Uploading button. You will need to know the contract/policy number and the owner’s zip code to use this feature.
