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Forms

If you need a form that you don’t see here, you can access more forms within our customer portal. It’s easy to create an account, and it allows you to manage your policy information 24 hours per day, 7 days per week.

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Customer forms

Preneed death claim form

This form should be used for Preneed Funeral insurance claims in all states except Kentucky, Indiana, Texas, and Tennessee.

Download form

     

Final Expense insurance claim form

Use this form to submit a claim for a Final Expense life insurance benefit.

Download form

     

Claim form — Proof of death for Accidental Death Indemnity benefit only

Use this form to submit a claim for Accidental Death Indemnity benefit.

Download form

Preneed death claim form — Indiana

This form should be used for Preneed Funeral insurance claims in Indiana.

Download form

     

Preneed death claim form — Kentucky

This form should be used for Preneed Funeral insurance claims in Kentucky.

Download form

     

Preneed death claim form — Tennessee

This form should be used for Preneed Funeral insurance claims in Tennessee.

Download form

     

Preneed death claim form — Texas

This form should be used for Preneed Funeral insurance claims in Texas.

Download form

Provider forms

DVH guidelines for providers

For DVH plans underwritten by Medico®, download a form to submit claims for dental procedures, view a summary of benefits, or access the provider portal.

Download form

View summary of benefits

Access provider portal

Short-Term Care Facility Certification of Care

This is a form for NHA06, NHA07, or NHA30 policyholders who are moving from one facility to another or who are going into a facility for the first time. Staff from the facility need to submit this form. These plans are underwritten by Medico®.

Download form

Short-Term Care Monthly Verification of Continuing Care

This is a form must be completed by facility staff. It is used to verify continuing care for NHA06, NHA07, or NHA30 policyholders. It must be submitted with each month’s bill. These plans are underwritten by Medico®.

Download form

Recent blog posts

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Recent blog posts

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How to write a eulogy that is heartfelt

Finding the right words might seem impossible. But if you break down how to write a eulogy in a few steps, the process can seem a lot less scary.

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Latest company news

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Wellabe launches first product under its new brand

Wellabe has launched a Short-term Care insurance plan that offers coverage for extended care in the home or in a facility in 10 states.

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Current job openings

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