Start A Claim

Please note that you are not actually submitting a claim.

By pressing Submit, you are requesting a member of our Claims Team to call you back to initiate the Claims Process.

Primary Insured's Information
Coverage ID

The primary insured's coverage ID will start with a 6, 7, or 8 and must be 9-digits
Insured's Name
Insured's Name
First Middle Last Suffix
Insured's Address
Insured's Address*
Street Address Address Line 2 City State ZIP Code
What Insurance do You Have?
Type of insurance?*
Accident or Death*
What was the date of death or accident?
Date of death or accident?*
MM slash DD slash YYYY
What was the first day of hospitalization?
First day of hospitalization?*
MM slash DD slash YYYY
How Many Days Hospitalized?
How many days was the policyholder hospitalized?*
Please enter a number greater than or equal to 1.
When is the best time of day for a claims agent to reach you?
When is the best time of day for a claims agent to reach you?
Our claims agents are available Monday through Friday from 8 AM to 6 PM EST
In which timezone are you located?
Comments
This field is for validation purposes and should be left unchanged.

Your Information