Forms

The following forms are available for download in a PDF format.

If you do not find a form you require, you may Contact Us.

Post Tax Brochures

Coverage availability varies from agency to agency.

• Hyatt Legal Plans (DOT Only)
• Hyatt Legal Plans (DCF/APD Only)

Pretax Brochures

Coverage available in all agencies and universities.

Application Forms

• Hartford Long-Term Disability (DOT Only)

Beneficiary Change Forms

• Alta Group Term Life Insurance
• Hartford Accidental Death & Dismemberment
• Hartford Group Term Life

Conversion Forms

• Hartford Accidental Death & Dismemberment
• Hartford Long-Term Disability (DOT Only)
• Alta Hospital Supplement 30/20 & PPP & SIS Continuation Form
• Alta Hospital Supplement 365+ Continuation Form

Claim Forms

• Hartford Long-Term Disability (DOT Only)
• Alta Term Life Accidental Dismemberment - Deduction code 0262
• Alta Term Life Waiver of Premium Form - Deduction code 0262
• Alta Disability Claim Form - Deduction code 0300
• Alta Hospital Supplement Claim Form
• Alta Group Term Life Claim Form - Deduction code 0262
• Aflac Cancer Claim Form
• Aflac Hospital Intensive Care Claim Form
• Aflac Wellness Claim Form