Insurance Forms
Staff Contact: Marybelle Hansen
Fusion Eye Care |
||||
|
Accelerated
Benefit Form Basic
Life/ADD and Supplemental Life Claim Form Beneficiary
Designation Form Evidence
of Insurability Form Life
Conversion Form Waiver
of Premium Claim Form Dismemberment
Claim Form |
Evidence
of Insurability Form HIPAA Authorization – please complete for claims |
Dental Application (New members) Claim
Form Benefit and Claims Information and Participating Provide Dentist Notice
of Insurance Continuation Form First
Ameritas Privacy Policy I.D.
Card Nominating
Dentist Form |
NYS
DBL Claim Form |
- The 2007 Summary Annual Report for The Business Council's Insurance Fund.
- The 2006 Summary Annual Report for The Business Council's Insurance Fund.
- The 2005 Summary Annual Report for The Business Council's Insurance Fund.
- The 2004 Summary Annual Report for The Business Council's Insurance Fund.
- Internal Revenue Code Section 79, Table I for Group Life Insurance
Forms are in
(Portable
Document Format). For help downloading, click here to ![]()