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Downloads
Use this page to download forms you may need to submit claims, change a beneficiary, or other services. Choose from the list of forms below.
Some of these forms are Interactive and enable you to type in the information in select fields and print your completed form. Although you cannot save a completed copy of the form on your computer, you may complete the form and print out two copies: one to mail and one for your records. You also have the option to print an interactive form blank and handwrite your information on the form.
If you have any questions regarding these forms, or would like AMA Insurance Agency to mail you a form, please contact us.
Instructions to Download Forms
1. You must have Adobe Acrobat Reader installed on your computer. Don't have it? Download it now for free.
2. Click one of the links below to download a form.
3. Print the form using Adobe Acrobat Reader.
4. Complete the form and mail it to the address indicated in the form instructions.
Caremark Mail Order form |
Mail order form for prescription drugs |
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Dental Insurance Claim Form |
Claim form for dental services |
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Disability Income Insurance Plan Form |
Future Benefit Increase Benefit Form |
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Domestic Partnership Declaration Form |
Completion of this form is required to secure coverage on available plans for domestic partners. Please contact AMA Insurance Agency at 1-888-627-5883 for plan availability. |
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Electronic Fund Transfer(EFT) Payment Option Form |
For Insureds covered in the Level Term Life, Preferred Term Life, Accidental Death and Dismemberment, Catastrophic Major Medical, Disability Income, Retirement Funding Disability, Hospital Income, Medicare Supplement and Office Overhead Expense plans. |
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Catastrophic Major Medical Insurance Plan Claim Form |
Claim Form - Catastrophic Major Medical Insurance |
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Catastrophic Major Medical Insurance Plan Dependent Coverage Form (New York Residents Only) |
Dependent Coverage Form - Catastrophic Major Medical Insurance (New York Residents Only) |
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Catastrophic Major Medical Insurance Plan Dependent Coverage Form (All U.S. Residents EXCEPT New York) |
Dependent Coverage Form - Catastrophic Major Medical Insurance (All U.S. Residents EXCEPT New York) |
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Prescription Drug Claim Form |
Claim Form - Prescription Drug Claim Form |
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Office Overhead Expense Plan - Group Professional Overhead Expense Report |
Expense Report - Office Overhead Expense Plan |
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Application for Disability Benefits |
Disability Income Insurance Benefits Form |
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Hospital Income Insurance Plan Claim Form (must submit with Authorization Form)Hospital Authorization Form (must submit with Claim Form)
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Claim Form - Hospital Income Insurance
Authorization Form - Hospital Authorization Form
NOTE: THESE TWO FORMS MUST BE SUBMITTED TOGETHER. |
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Wording for Beneficiary Designations |
Download and refer to this document for examples of the types of commonly requested beneficiary designations. |
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Form AMA-ASGT |
Changes the beneficiary and assignment to an individual or trust agreement. |
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Form AMA-ASGT 2 |
Changes the assignment back to the insured. |
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Form AMA-BENE |
Names an individual, corporation or partnership as beneficiary; entities can be named as primary or as contingent. |
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Form AMA-PLW |
Names an individual as the primary beneficiary and the trustee designated in the last will and testament of the insured as the contingent beneficiary. |
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Form AMA-IVT |
Names a trust agreement as beneficiary. |
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Form AMA-TRT |
Names the trustee designated in the last will and testament of the insured as the beneficiary. |
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