- HIPPA AUTHORIZATION RELEASE FORM

- DOCTOR'S VISITS FORM (HOSPITAL & ACCIDENT PLAN) * itemized bill needed with CPT Codes

- WELLNESS CLAIM FORM (CANCER PLAN)

- DIRECT DEPOSIT FORM

- HOSPITAL PLAN CLAIM FORM

Click Links Below To Download Claim Forms (pdf)

- ACCIDENT CLAIM FORM (AP2 / AP3)

- GROUP ACCIDENT CLAIM FORM (GVAP1 / GVAP6)

- CANCER / SPECIFIED DISEASE / ICU / HEART / STROKE CLAIMS

How Do I Know What Type Of Claim(s) To File?

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I went to see a doctor

I had my wellness check-up

I would like my claims money deposited into my bank account

I was admitted to the hospital or had inpatient surgery

I had an accident

I was treated for cancer/covered heart condition or stroke

- DISABILITY CLAIM FORM

I have a disability claim to file

Authorization to disclose protective health information

I had an accident

Claim Forms

File my claim(s) online through the Allstate Benefits website

I prefer to complete my claim forms manually with the forms below.

CLICK HERE.

Or

Fax Claim Forms To 1(866)424-8482

Where Do I Send My Itemized Bills & Claim Forms?

I had outpatient surgery

Check my claim status, view coverage and benefit information or update my profile

CLICK HERE.

WELCOME VALUED CLIENTS OF AMERICAN INSURANCE PLUS

THANK YOU FOR YOUR BUSINESS

- HOSPITAL PLAN CLAIM FORM

I need my policy number(s)

1st time users will need to register.

CLICK HERE.

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