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Cancer Forms


Please read your policy closely.

Cancer policies provide specified benefits for certain treatments, procedures, and services rendered to the policyholder for the treatment of cancer. These limited benefit policies only pay benefits for those items listed in your policy and they do not pay for all treatments, procedures, or services you may receive with your cancer treatment.

Please take a moment to read these important and helpful guidelines regarding how to file your cancer claim.

 
   
Claim Forms
  • Cancer Screening Benefit Form
  • First Occurrence Benefit Form
  • Cancer Claim Form (Former Colonial and Life of Georgia policies)
  • Cancer Claim Form (all other policies)
  • Cancer Claim Form (EMC policies)
  • Premium Waiver Form
  • Transportation/Mileage Reimbursement Form
  • Other Forms
  • Affidavit of Lost Policy Form
  • Bank Draft Authorization Form (In English) / (en Espaņol)
  • Health Policy Cancellation Form
  • HIPAA Form (release PHI from provider) / Agent HIPAA Form (release PHI to agent) / Family HIPAA Form (release PHI to Family Member/Other 3rd Party)
  • Persistency Bonus/Return of Premium Surrender
  • Policy Service Form



  • Additional Information

    Toll Free Number
    1-800-669-9030

    Email Us

    CS@manhattanlife.com



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