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Claims Forms

Administering a benefit plan can be a complicated job for any administrator. To make things easier for you, we maintain an online Forms Library for easy access to the forms you need for these coverages:

  • Association Group Term Life
  • Association Personal Accident Insurance (PAI)
  • Association Disability Income Insurance (DI)
  • Individual Yearly Renewable Term Life (YRT)
  • Individual Three-Year Term Life (TriTerm)

Note that forms on this site are standard Claim and Administration forms. Any Enrollment or Application forms must be obtained through your Account Manager.

When printing multiple-page forms, please make every reasonable attempt to print these as 2-sided pages.

Remember to complete any applicable Administrator or Employer section(s) before distributing forms to insureds or beneficiaries.

Please contact your Account Manager for any questions you may have regarding the use of these forms.

You may contact Voya® Association Sales at 800-372-5288.

Death Claims+

Remember to complete any applicable Administrator or Employer section(s) before distributing forms to beneficiaries.

Frequently Asked Questions for Death Claims

To submit a claim, you need to distribute the following forms to EACH beneficiary:

  • Claim form
  • Voya® Personal Transition Account Supplemental Contract (not applicable for beneficiaries residing in Alaska, Illinois, Kansas, North Carolina or Nevada)
  • If a Trust is named as the beneficiary, the Trust Verification form must be completed by the trustee of the trust.
Waiver of Premium Claims+

Not all plans have this option -- check the policy or certificate. There may also be eligibility limits for this benefit (i.e. the insured usually has to be under age 60 to apply). Remember to complete any applicable Administrator or Employer section(s) before distributing forms to insureds.

To submit a claim, you need to distribute the following forms to the insured:

  • Claim form
  • Attending Physician's Statement of Disability
  • Authorization for Release of Health-Related Information
  • Consumer Privacy Notice
Accelerated Benefit Claims+

Not all plans have this option -- check the policy or certificate. Remember to complete any applicable Administrator section(s) before distributing forms to insureds.

To submit a claim, you need to distribute the following forms to the insured:

  • Claim form
  • Attending Physician's Statement of Terminal Condition
  • Authorization for Release of Health-Related Information
  • Consumer Privacy Notice
  • Disclosure Statement (n/a for New York policies)
Accident and Accidental Dismemberment Claims+

Not all plans have this option -- check the certificate. Remember to complete any applicable Administrator section(s) before distributing forms to insureds.

To submit a claim, you need to distribute the following forms to the insured:

  • Claim form
  • Attending Physician's Statement of Dismemberment
  • Authorization for Release of Health-Related Information
  • Consumer Privacy Notice
Total and Permanent Disability Claims (NY)+

For Group Term Life (New York ONLY)

To submit a claim, you need to distribute the following forms to the insured:

  • Claim form
  • Attending Physician's Statement of Disability
  • Authorization for Release of Health-Related Information
  • Consumer Privacy Notice
Disability Income Claims+

To submit a claim, you need to distribute the following forms to the insured:

  1. Disability Income Claim Filing Instructions
  2. Insured Statement
  3. Attending Physician’s Statement of Disability
  4. Employer/Business Owner Statement
  5. Disability Income Occupational Demands
  6. Authorization for Release of Health-Related Information, and
  7. Consumer Privacy Notice

Administration Forms

The forms provided here are standard Administration forms, other than Claims. Any Enrollment or Application forms must be obtained through your Account Manager.

Change Request Forms+

The forms below allow you the make changes to an insured’s policy.

  • Use the Request for Change form to process changes such as name or address, and coverage reductions or terminations.
  • Use the Amendment to Original Application if a person needs to switch his/her status to “non-tobacco user” for the purpose of premium rates. This is not available on all plans.
Beneficiary Designation+

The completed form must be sent to the insurer for approval (along with copies of all enrollment forms or applications, beneficiary changes and assignments) in any of the following situations:

  • If the designation differs from the examples on page 2 of the form,
  • If the coverage has been assigned,
  • If the previous beneficiary was irrevocable,
  • If coverage is under an individual policy, or
  • If the insurer maintains all the beneficiary designation records for your plan.
Assignment of Life Insurance+

If the current owner of life insurance wants to assign ownership of coverage, then the current owner and the new owner must complete and sign this form. Check the policy or certificate to determine what types of assignments are allowed.

The completed form must be sent to the insurer for approval, along with copies of all enrollment forms or applications, beneficiary designations and past assignments.

Statement of Intent+

If group life insurance was assigned under a prior group policy, then in order to continue the assignment under the new Group Policy the insured person and the owner must complete and sign a Statement of Intent form.

The completed form must be sent to the insurer for approval, along with copies of all enrollment forms or applications, beneficiary designations and the prior absolute assignment.

Life Conversion+

Use this form when insured and/or dependent life coverage becomes eligible for conversion.

  • Check the group policy or certificate for the Conditions for Conversion.
  • Remember to complete the Employer or Administrator section(s) before distributing the form to the insured person(s).
  • If ownership of coverage is assigned, the form must be distributed to the owner instead of to the insured person.
  • NOTE: There are time limits that pertain to your distribution of this form and the recipient's return of the completed form to the insurance company. See the policy or certificate for details.
  • NOTE: This form must be provided each time life coverage becomes eligible for conversion, even if the insured person may also be eligible for other benefits under the group policy.

Insurance products in the U.S. are provided by ReliaStar Life Insurance Company (Home and Administration Office: Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Home Office: Woodbury, NY. Administration Office: Minneapolis, MN). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya® family of companies. Product availability and specific provisions may vary by state.