MedMutual Life and Disability Forms
Beneficiary Forms & Resources
Beneficiary Form (available online on My Health Plan by visiting the Forms page under Resources & Tools)
Beneficiary Designation Form (PDF version)
Beneficiary's Checklist (Important Reminders for When a Loved One Dies)
Claim Forms
Accident
Death
Death (individual policyholders only)
Individual and Small Group Accident, Critical Illness and Hospital Indemnity
Large Group Accident and Critical Illness
Long-term Disability
Multi-claim Form (short-term disability, waiver of premium and accelerated death benefit)
Waiver of Premium
Wellness Benefit
Group Applications
ITFMPE
Life and Disability
PEBA
COSE
MRACC
TRCC
Miscellaneous
Conversion Form
Employee Enrollment Form
Voluntary Life and Short-term Disability Employee Enrollment Form
Evidence of Insurability Form (Georgia form available below)
Group Disability Insurance Request for Direct Deposit via ACH
Life Portability Application