Forms Library

The list below contains all forms available for download on this website. If you have any questions about these forms, or would like AMA Insurance to mail you a form instead, please contact us.

Please note that some of the forms below allow you to type information directly into the PDF, however, for privacy purposes, you may not save a filled out form.

Health Insurance Forms

Health Insurance Forms


Caremark Mail Order Form

Mail order form for prescription drugs

Group Hospital Income Insurance Dependent Coverage Form  

Dependent Coverage Form - Group Hospital Indemnity Insurance


Health Insurance Claim Forms and Resources


CMM Claim Form

Catastrophic Major Medical Claim Form

CMM Hospital Directory

A Directory of Hospitals in the Catastrophic Major Medical Discount Network – Admittance to a network hospital is recommended but not required by this plan.

Group Hospital Income Insurance Plan Claim Form

Claim Form - Group Hospital Indemnity Insurance CLAIM FILING INSTRUCTIONS Complete, date, sign and return with one of the following:
-- A UB-04 form issued by the hospital
-- An itemized hospital bill, along with a diagnosis provided by your attending physician. A balance due statement is not acceptable.
-- A statement from the hospital indicating the admission date, discharge date, number of days, type of room and the diagnosis.


Caremark Prescription Forms and Resources


Prescription Drug Claim Form

Claim Form - Prescription Drug Claim Form

Mail Order Form

Pharmacy Locator

Prescription Drug Pricing
Life Insurance Forms

Life Insurance Forms


Wording for Beneficiary Designations

Download and refer to this document for examples of the types of commonly requested beneficiary designations.

Form AMA-ASGT

Changes the beneficiary and assignment to an individual or trust agreement.

Form AMA-ASGT 2

Changes the assignment back to the insured.

Form AMA-BENE

Names an individual, corporation or partnership as beneficiary; entities can be named as primary or as contingent.

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.

Form AMA-IVT

Names a trust agreement as beneficiary.

Form AMA-TRT

Names the trustee designated in the last will and testament of the insured as the beneficiary.

Life Insurance Claim Forms


Life Insurance Accelerated Benefits Request Form

Accelerated Life Benefit Request 

Return completed form to:  
AMA Insurance  
330 N. Wabash Ave., Suite 39300  
Chicago, IL 60611-5885 

Disability Insurance Forms

Disability Insurance Forms


Disability Income Insurance Plan Form

Future Benefit Increase Form


Disability Claim Forms


Application for Disability Benefits

Disability Income Insurance Benefits Form

Office Overhead Expense Plan - Group Professional Overhead Expense Report

Expense Report - Office Overhead Expense Plan

Dental Insurance Forms

Dental Insurance Claim Forms


Dental Insurance Claim Form

Claim form for dental services

Additional Forms
Electronic Fund Transfer(EFT) Payment Option Form

Save time by switching to monthly automatic EFT payments. Complete this form and return it to AMA Insurance today.

Domestic Partnership Declaration Form

For Insureds covered in the Level Term Life, Preferred Term Life, Hospital Income, Medicare Supplement, Office Overhead Expense, Pure Term Life, Mature Decisions Life, and LIFEPace Term Life plans. 

Third Party Designee Form

Use this form to add another party to receive billing and lapse notices to help prevent unintentional lapse of insurance coverage.

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