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Claims & Insurance Forms
Looking to submit a claim or change a beneficiary? Here's our complete library of forms in one place.
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
Mail order form for prescription drugs
Dependent Coverage Form - Group Hospital Indemnity Insurance
Health Insurance Claim Forms and Resources
Catastrophic Major Medical Claim Form
A Directory of Hospitals in the Catastrophic Major Medical Discount Network – Admittance to a network hospital is recommended but not required by this plan.
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
Claim Form - Prescription Drug Claim Form
Life Insurance Forms
Download and refer to this document for examples of the types of commonly requested beneficiary designations.
Changes the beneficiary and assignment to an individual or trust agreement.
Changes the assignment back to the insured.
Names an individual, corporation or partnership as beneficiary; entities can be named as primary or as contingent.
Names an individual as the primary beneficiary and the trustee designated in the last will and testament of the insured as the contingent beneficiary.
Names a trust agreement as beneficiary.
Names the trustee designated in the last will and testament of the insured as the beneficiary.
Life Insurance Claim Forms
Accelerated Life Benefit Request
Return completed form to:
330 N. Wabash Ave., Suite 39300
Chicago, IL 60611-5885
Disability Insurance Forms
Future Benefit Increase Form
Disability Claim Forms
Disability Income Insurance Benefits Form
Expense Report - Office Overhead Expense Plan
Dental Insurance Claim Forms
Claim form for dental services
Save time by switching to monthly automatic EFT payments. Complete this form and return it to AMA Insurance today.
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.
Use this form to add another party to receive billing and lapse notices to help prevent unintentional lapse of insurance coverage.