Forms and Guides

Forms

Employer Stop Loss:
Application
Aggregate Claim
Disclosure Instructions
Monthly Aggregate Report
Specific Claim

HM Care Advantage:
Claim
Employee Enrollment
Group Application Dental/Rx
Group Application Medical
New Business Transmittal
Proposal Request

HM Benefits Administrators:
Retiree Claim Forms

HM Worksite Advantage:
Accident
Cancer
Critical Illness
Disability Income
Supplemental Hospital Indemnity
Term Life
Universal Life/Whole Life

Federal and Tax Forms:
W-9 Forms
Tax Brochures

Other Forms:
Reimbursement Direct Deposit Authorization

*In Pennsylvania, Employer Stop Loss coverage may be underwritten by our Casualty Insurance Company.

HM Worksite Advantage Forms

Disability Income

Applications

Group Application

Employee Enrollment

Claim Form

Claim Notice: If your HM Worksite Advantage Disability Income coverage is administered by Continental American Insurance Company (CAIC), please contact CAIC at 866.849.2954 to obtain the appropriate claim form.