ONLINE SERVICES
Forms
For your convenience, all our claim and service forms are available online. Download and print them as many times as you want.
Claims
Claim Forms
Accident
📄 Download PDF
Cancer / Illness
📄 Download PDF
Preventive Testing
📄 Download PDF
Initial Disability
📄 Download PDF
Disability Continuation
📄 Download PDF
Death
📄 Download PDF
Services
Service Forms
Amendment or Service Request
📄 Download PDF
Payroll Deduction Authorization
📄 Download PDF
Electronic Transfer Authorization
📄 Download PDF
Reinstatement Request — Cancer and Supplemental
📄 Download PDF
Supplemental Plan Conversion
📄 Download PDF
Privacy Policy
📄 Download PDF
Direct Deposit of Claim Payments
📄 Download PDF
Requirements
Checklist of claim requirements
Requirements for Cancer Única
📄 Download PDF
Requirements for Cancer Elite
📄 Download PDF
Requirements for Organ Transplant
📄 Download PDF
Florida, USA
Florida, USA Forms
Claim and service forms for policyholders of our supplemental plans in Florida.
Accident
📄 Download PDF
Cancer / Illness
📄 Download PDF
Preventive Testing
📄 Download PDF
Change of Beneficiary Designation
📄 Download PDF
Change of Coverage
📄 Download PDF
Change of Payor
📄 Download PDF
Name Correction
📄 Download PDF
Addition of Dependent
📄 Download PDF
Removal of Dependents
📄 Download PDF
Change of Payment Mode
📄 Download PDF
Reinstatement Request
📄 Download PDF
How to submit a form?
Download and complete the corresponding form. Then you can submit it by email to customerservice@tolic.com, by fax to 787-620-2713, deliver it to your authorized representative or bring it to the TOLIC office.