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USAble Life
Claim forms
- Accelerated Death Benefit
- Accidental Death and Dismemberment (AD&D)
- Life - Proof of Death
- LTD - Please call USAble Customer Service at 1-800-370-5856.
- Short Term Disability Income Benefits (paper submission)
- Short Term Disability Income Benefits (telephonic submission)
- Waiver of Premium - Application for Extended Insurance Benefits
Application forms
- Evidence of Insurability
- Application Trust Group Life/AD&D/Dependent Life/STD
- Application for BCBSNC Coverage (Group combined Health and Life)
- Application Trust Group LTD
- W-2 Agreement
- Application (Group Products, Basic and Voluntary)
Enrollment forms
- Group Enrollment or Change form
- Enrollment Voluntary Products
- Enrollment Voluntary STD
- Enrollment and Change Application with health questions (1-24 employees)
- Spanish Enrollment and Change Application with health questions (1-24 employees)
- Enrollment and Change Application (25+ employees)
- Spanish Enrollment and Change Application (25+ employees)
Miscellaneous forms
- Beneficiary Change Form
- Continuation of Voluntary Group Term Life
(for employees whose employer has selected the portability provision) - Appointment of Authorized Representative
- Conversion for Group Life
- Update Form – Short Term Disability
- Employee Payroll Deduction Form