AICK forms for enrollment, claims and more.

Employee Enrollment Forms

• Basic Coverage – Term Life, AD&D, Dependent Life, Short Term Disability and Long Term Disability
  (Form AICK-4)
• Basic Coverage (Spanish Version) – Term Life, AD&D, Dependent Life, Short Term Disability and Long Term Disability
  (Formulario De Inscripción – Para Empleados Para Coberturagrupal)
  (Form AICK-4SP)
• Evidence of Insurability Form
  (Form AICK 4C)
• Formulario de evidencia de asegurabilidad (Spanish Version)
  (Form AICK 4Ces)
• Evidence of Insurability Form - use with AICK-4
  (Form AICK 4EV)
• Voluntary Life
  (Form AICK 400)
• Voluntary AD&D, Voluntary Short Term Disability, Voluntary Long Term Disability and Voluntary Life
  (Form AICK 300)
• Voluntary Short Term Disability Form
  (Form AICK 8003)

Claim Forms

• Death Claim Form
  (Form AICK 16)
• Disability Claim Form - STD, LTD and Waiver
  (Form AICK 18)
• LTD Payment Options
  (AICK 49)
• HIPAA Authorization
  (AICK 41A)
• Medical History
  (AICK 46)
• Continuance of Disability
  (AICK 24)

Miscellaneous Forms

• Request for Change ― Change of Beneficiary, Name change, etc.
  (Form AICK 5)
• Application for Portability (Voluntary Life only)
  (Form AICK 170)
• Beneficiary Designation Form
  (Form AICK 7)
• Notice of Conversion Privilege
  (Form AICK 12)
• Group Administrator Supply Order Form
• Notice of Terminated Employees
• Automatic Payment Authorization
  (Form AICK 25A)
• Disabled Dependent Application
  (AICK 21)
• Waiver of Coverage
  (AICK Waiver)
• Waiver of Coverage (Spanish Version)
  (Renuncia de inscripción Rechazar el seguro de vida grupal o de discapacidad)
  (AICK Waiver ES)

Individual Coverage Forms

• Death Claim Form
  (Form AICK 17)
• Individual Change Form
  (AICK 6)

Group Pre-enrollment Forms

• Application for Group Insurance
  (Form AICK 100)
• Small Group Employer Application
  (Form AICK 290)