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Health and Accident Forms

Claim Forms
  • Critical Illness Claim Form
  • Disability Claim Form
  • Medical Illness Claim Form
  • Medical Accident Claim Form (In English) / (en Espaņol)
  • Premium Waiver Form
    •
    Other Forms
  • Affidavit of Lost Policy Form
  • Bank Draft Authorization Form (In English) / (en Espaņol)
  • Beneficiary Change Form
  • 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
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    Additional Information

    Toll Free Number
    1-800-669-9030

    Email Us
    CS@manhattanlife.com



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