Forms and Guides

Forms

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

HM Care Advantage:
Claim
Dental Claim (Renaissance Only)
Employee Enrollment
Group Application Medical
NY Offer of Benefits Notice
Group Application Dental/Rx
New Business Transmittal
Proposal Request

HM Worksite Advantage:
Accident
Critical Illness
Disability Income
Term Life

Federal and Tax Forms:
W-9 Forms

HM Benefits Administrators:
Retiree Claim Forms
Carmeuse Lime & Stone Retiree Forms

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

Employer Stop Loss

Application for stop loss insurance

Aggregate stop loss claim

Disclosure instructions

Monthly aggregate report

Specific stop loss claim

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