Combined Life Insurance Form Ny

If you are filing for the medical expense benefit only under your accident policy a claim form may not be needed if the following information is submitted on a timely basis.

Combined life insurance form ny. Through our health insurance benefits portal you ll have a comprehensive avenue to optimize your health care experience. There are two areas for your signature marked with an x at the bottom of the first page 5. Print all six pages of the claim form 3. In new york products are underwritten by combined life insurance company of new york latham ny.

Itemized medical bill s clearly indicating the name and address of the patient diagnosis or nature of the injury date and. Combined life insurance company of new york claim department p o. Combined insurance worksite solutions a unit of combined life insurance company of new york claim department po box 6700 scranton pa 18505 0700 1 888 441 7936 fax number. Download the claim form 2.

Box 6700 scranton pa 18505 0700 any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing. We believe in the importance of human guidance and in trusted relationships built on being there when our customers. Day year. Combined life insurance company of new york instructions for filing accident and health claims.

This is the company s eighth consecutive year on the top 10 list and fifth consecutive year in the top 5 combined insurance was previously named the number one military friendly employer in the nation for 2015 and 2016. With direct access to combined insurance s self service portal you ll round the clock customer service and support that allows you to take charge of your health and health care benefits. Box 6700 scranton pa 18505 0700 telephone 1 800 951 6206 fax 312 351 6930. Please print do not write mo.

The form must be completed in detail including the employer s statement in section c. Complete the first page of the claim form including section b or c and sections d and e. Combined life insurance company of new york claim department p o. In accordance with the beneficiary provisions of the policy i hereby request combined life insurance company of new york to pay the death benefit of the insurance policy above according to the beneficiary designations indicated and hereby revoke all prior named beneficiary designations.

In new york products are underwritten by combined life insurance company of new york latham ny. Download service forms which allows you to request certain changes or transactions on the new york life products you own. You must sign and date this claim form on the signature line provided on this page. Combined life insurance company of new york instructions for filing accident and health claims.

If you do not sign this claim form we cannot accept your claim submission.