Forms
Title | Purpose | Action |
---|---|---|
EFT Setup for Long Term Disability Claim Payments (All states except NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
EFT Setup for Long Term Disability Claim Payments (NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
Health Maintenance Screening Benefit Claim Form | Log in to file a Health Maintenance Screening claim. If you prefer paper forms, you may request a claim packet from your benefits administrator (HR team). |
Log In |
Long Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York. |
Download |
Long Term Disability Claim Packet (NY) | Use this packet to file a claim for a Long Term Disability plan issued in the state of New York. |
Download |
Short Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Short Term Disability plan issued outside of the states of New York. |
Download |
Short Term Disability Claim Packet (NY) | Use this packet to file a claim for a Short Term Disability plan issued in the state of New York. |
Download |
State Disability Claim Packet (NJ) | Use this packet to file a claim through a New Jersey State Disability plan. |
Download |
State Disability Claim Packet (NY) | Use this packet to file a claim through a New York State Disability plan. |
Download |