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Group Claims | Group Administration | Providers | Brokers/Agents | Individual Life
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Form ID
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Form Description
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Dental Claim Form - This is the standard claim form created by the American Dental Association. It must be completed by your Dental provider.
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GG015197
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Critical Illiness Claim Form
This is the standard claim form to use when submitting a claim on a Guardian Critical Illness insurance policy (claims for critical illness, hospital admission and/or wellness benefits for the policy). The following states have state-specific forms which need to be completed instead of the standard form: AK, AR, AZ, CA, CO, DC, DE, ID, KY, LA, MN, OH, OK, OR, PA, TX and VT. Log on to Guardian Anytime for a claim form specific to your state.
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CMS-1500
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Medical Claim Form One of the most widely-used medical claim forms in the United States is CMS-1500, formerly known as HCFA-1500. In fact, many states have legislated this to be the primary claim form to be used by your physician or other medical provider.
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GG-42
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Life Claim Form
This form consists of three sections, the claimant section, the employer section and the physician section. All sections must be completed and signed appropriately. This form is primarily for New York groups as some states have different forms.
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GG-011096
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Short Term Disability Claim
This form consists of three sections, the claimant section, the employer section and the physician section. All sections must be completed and signed appropriately. This form is primarily for New York groups as some states have different forms.
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The following forms are utilized for Long Term Disability claims. All sections must be completed and signed appropriately. This form is primarily for New York groups as some states have different forms.
If you can't find the form you're looking for, login to Guardian Anytime for additional claim forms.
For Guardian Group Products
If you can't find the form you're looking for, login to Guardian Anytime for additional claim forms.
For First Commonwealth Dental Products
Please use our Materials Request Form to request enrollment kits, Spanish language forms, copayment schedules, and more.
For First Commonwealth Dental Products
If you can't find materials you're looking for, use our Materials Request Form to contact us for more assistance.
For First Commonwealth Dental Products
At this time, we do not offer any materials for download via the Web. Please use our Materials Request Form to contact us for more assistance .
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Form ID
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Form Description
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T-94
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Change of Beneficiary Form
By completing this form the beneficiary designation will be changed as indicated. Once the company receives this form, all other beneficiary documents become null and void. That means if you want any of the beneficiaries prevously named to continue as your beneficiaries, you must include their names on this form.
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T-95
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Change of Beneficiary and Owner Form
By completing this form the owner and beneficiary designation will be changed as indicated. Once the company receives this form, all other documents pertaining to ownership and beneficiaries will be null and void. That means if you want any of the beneficiaries previously named to continue as beneficiaries, you must include their names on the form. Otherwise, the new owner will become the primary and sole beneficiary.
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R-223
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GOM Form
By completing this form you can setup a monthly draft for premium payments or change your banking information. When setting up a draft or changing bank information, please include a voided check with your form.
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