Forms

Forms  

Forms

Important forms to apply for and manage your coverage.

Forms

 

Below are important forms to apply for or to manage your coverage.


These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing. Click here to download a free copy of Adobe Acrobat Reader.

Expand All

|

Collapse All

  • Accidental Death & Dismemberment

    Application Form

    You can apply online for new coverage or increase existing coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

     

    Beneficiary Form

    Review and update your current beneficiary designations online in My Account. You may wish to complete a paper Beneficiary Designation form to make your designation, particularly if you have estate tax considerations or have needs that are more complicated that this online system allows. We strongly encourage you to consult the legal advice of an attorney in these instances. If you submit your beneficiary designation via a paper form, we will enter it into the Cigna Trusted Advisor® website so you can view it online through “My Account”.

     

    Domestic Partner Affidavit

    In order to file a claim for benefits, proof of the domestic partnership must be furnished the same as proof of a marriage. An Affidavit of Domestic Partnership form may be found on the Insperity PremierTM Platform (portal.insperity.com), or by contacting Insperity toll-free at 866.715.3552.

     

    Request for Change Form

    Use this form to make changes to the features and benefits of your AD&D, including reducing your coverage or changing from Employee Only to Employee + Family coverage.

     

    Surrender/Cancel Form

    Use this form to cancel/surrender AD&D coverage for You and/or your Family

     

    Claim Forms

    The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

     

    Return completed AD&D Claim Forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

  • Disability

    Application Form

    You can apply online for new coverage or increase existing coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

     

    Surrender/Cancel Form

    Use this form to cancel/surrender Disability coverage

     

    Claim Forms

    The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

     

    Return completed claim forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

     

    Long-Term Disability Claim Form
    Long-Term Disability Disclosure Authorization Form

  • Group Universal Life

    Application Form

    You can apply online for new coverage or increase existing coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

     

    Beneficiary Form

    Review and update your current beneficiary designations online in My Account. You may wish to complete a paper Beneficiary Designation form to make your designation, particularly if you have estate tax considerations or have needs that are more complicated that this online system allows. We strongly encourage you to consult the legal advice of an attorney in these instances. If you submit your beneficiary designation via a paper form, we will enter it into the Cigna Trusted Advisor® website so you can view it online through “My Account”.

     

    Domestic Partner Affidavit

    In order to file a claim for benefits, proof of the domestic partnership must be furnished the same as proof of a marriage. An Affidavit of Domestic Partnership form may be found on the Insperity PremierTM Platform (portal.insperity.com), or by contacting Insperity toll-free at 866.715.3552.

     

    Coverage Earnings/Coverage Increase Request Form

    Use this form to request a GUL coverage increase due to a recent change in Covered Earnings

     

    Funds Withdrawal Form

    Use this form to withdraw funds from your GUL Cash Accumulation Fund or to cancel your contributions.

     

    Request for Change Form

    Use this form to make changes to the features and benefits of your GUL (other than increasing coverage), including reducing your coverage or cancelling coverage for your children

     

    Surrender/Cancel Form

    Use this form to cancel/surrender GUL coverage for You and/or your Spouse/Domestic Partner

     

    Claim Forms

    The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

     

    Return completed GUL claim forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

     

    Group Universal Life Insurance Claim Form
    Accelerated Payment Benefit Claim Form

Expand All

|

Collapse All

  • How/Where to Return Forms

    Completed Beneficiary Forms or Change Forms can be returned to the Cigna Customer Service Center:

     

     

    Completed Claim Forms can be returned to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193.