Employers

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.

Employers

Forms

HM Worksite Advantage Forms