Select the appropriate form below.

Refer to the Benefits Administration section of the Plan Administration Guide for information about filing a claim.

Life Insurance

•   SI 1794 - Life Claim Packet
•   SI 1794 SPU - Life Claim Packet - Spanish
•   SI 1794 ER - Life Claim Packet - Employer Portion
•   SI 1794 ER-SPU - Life Claim Packet - Employer Portion - Spanish
•   SI 1794 BEN - Life Claim Packet - Beneficiary Statement
•   SI 1794 BEN-SPU - Life Claim Packet - Beneficiary Statement - Spanish

AD&D

•   SI 2720 - Accidental Dismemberment Claim Packet
•   SI 2720 - Accidental Dismemberment Claim Packet - Spanish
•   SI 2720 ER - Accidental Dismemberment Claim Packet - Employer Portion
•   SI 2720 ER - Accidental Dismemberment Claim Packet - Employer Portion - Spanish
•   SI 2720 EE - Accidental Dismemberment Claim Packet - Employee Portion
•   SI 2720 EE - Accidental Dismemberment Claim Packet - Employee Portion - Spanish

Accelerated Benefits

•   SI 6913 - Accelerated Benefit Claim Packet
•   SI 6913 - Accelerated Benefit Claim Packet - Spanish
•   SI 6913 ER - Accelerated Benefit Claim Packet - Employer Portion
•   SI 6913 ER - Accelerated Benefit Claim Packet - Employer Portion - Spanish
•   SI 6913 EE - Accelerated Benefit Claim Packet - Employee Portion
•   SI 6913 EE - Accelerated Benefit Claim Packet - Employee Portion - Spanish

Waiver of Premium

•   SI 1284 - Waiver of Premium Claim Packet
•   SI 1284 - Waiver of Premium Claim Packet - Spanish
•   SI 1284 ER - Waiver of Premium Claim Packet - Employer Portion
•   SI 1284 ER - Waiver of Premium Claim Packet - Employer Portion - Spanish
•   SI 1284 EE - Waiver of Premium Claim Packet - Employee Portion
•   SI 1284 EE - Waiver of Premium Claim Packet - Employee Portion - Spanish