The list below contains forms available for download for current AMA Insurance policyholders. 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.

Change a Beneficiary

Life Insurance / Accidental Death & Dismemberment (Premier Accident) Insurance

Beneficiary Change Request

Transfer of Ownership and Beneficiary Designation
File a Claim

Dental Insurance


Dental Insurance Claim Form

File a claim for dental services.

Hospital Income (Hospital Indemnity) Insurance Plan


Hospital Income (Hospital Indemnity) Insurance Form

In order to file a claim, complete, date, sign and return this form 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 indicated the admission date, discharge date, number of days, type of room and diagnosis.

Catastrophic Major Medical/Excess Major Medical Insurance


Catastrophic Major Medical Claim Form

File a claim for Catastrophic Major Medical insurance.


For All Other Claims


Please contact Customer Care at 1-888-627-5883 (8 am – 5 pm CT, Monday – Friday).

Add Dependents

Hospital Income (Hospital Indemnity) Insurance Plan


Hospital Income (Hospital Indemnity) Dependent Enrollment Form

Add dependent(s) to your coverage.

Change Billing Information

Automatic Payments

Electronic Fund Transfer (EFT) Enrollment Form

Enroll in EFT to setup automatic monthly payments from your bank account.


Add Secondary Address


Add Secondary Address Form

Add another address/individual to your account. They will receive a copy of billing and lapse notices to help prevent unintentional lapse of insurance coverage.

Helpful Resources
Catastrophic Major Medical Insurance Hospital Directory

View the directory of hospitals in the CMM plan. Admittance to a network hospital is recommended but not required by this plan.

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