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Formularios en Español

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Service Forms

Service Forms

To make it easy for you to access the forms you need, we have placed commonly used service forms on this site for you to access at your convenience.

These forms are available in Adobe Acrobat PDF format. The PDF forms must be printed out and then completed. They cannot be completed online. Once you have printed and completed the form, mail or fax the form to Colonial.
CLAIM FORMS
Colonial Life & Accident Insurance Company
P.O. Box 100195
Columbia, SC 29202-3195
FAX: 1-800-880-9325


OTHER FORMS
Colonial Life & Accident Insurance Company
P.O. Box 1365
Columbia, SC 29202-1365

To order forms that aren’t listed here, please call the Colonial Service Center at 1-800-325-4368.
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Download Forms

Form Title Form# Description Form Availability
Request for Change of Ownership14001This PDF form should be used to update owner and/or contingent owner information on a policy.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Change of Beneficiary Form17075This PDF form should be used to add or modify the designated beneficiary on a policy.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Accident67715This PDF should be used to submit an accident claim. If you were out of work, please complete the disability claim form.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Catastrophic Accident57930This PDF should be used to submit a claim for the catastrophic accident benefit.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Continuing Disability46988This PDF should be used to submit a continuing disability claim.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Critical Illness65017This PDF should be used to submit a claim for the catastrophic accident benefit.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Disability64387This PDF should be used to submit a disability claim.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form - Group Supplemental Hospital Confinement60316This PDF should be used to submit a claim under the Group Supplemental Hospital policy offered by your employer, if available where you work.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Form and Instructions - Group Short-Term Disability19057This PDF should be used to submit a claim under the Group Short-Term Disability policy offered by your employer.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Medical Bridge 3000 Doctor's Office Visit Benefit Claim Form69121This PDF should only be used to submit a claim form for a doctor's office visit if you have a Medical Bridge 3000 policy.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Claim Fraud Warning and State Variations58147This PDF should be used to review state fraud warnings.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Express Filing of Pregnancy Claim49507This PDF should be used for the express filing of pregnancy claims. This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Loss of Life (death) Notification Formn/aSubmit Loss of Life Notification online.Complete this form online.This form is not available as a PDF.This form cannot be completed over the phone.
Request For Service05897Use this PDF form to request changes to personal data, beneficiary, or to exercise policy provisions.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Service Guide for Policyholders43233This helpful flier provides information on finding the most up-to-date claim forms, submitting a claim and selecting optional services on the claim form. The form also provides helpful tips about the claims process, how the policy works and when to contact the service center.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Universal Claim Formn/aThis PDF should be used to submit a claim under cancer, accident, critical illness and hospital confinement policies.This form is not available for online completion.View this form as a PDF.This form cannot be completed over the phone.
Wellness Claim Formn/aSubmit a wellness claim online.Complete this form online.This form is not available as a PDF.This form cannot be completed over the phone.
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Formularios en Español

Título #forma Descripción Formatos
Formulario para la Designación de Beneficiario51578Este formulario se usa para designar un beneficiario primario o para seleccionar beneficiarios contingentes.Este formulario no está disponible para llenar en línea.Ver este formulario en formato de PDF.Este formulario no se puede completar por teléfono.
Formulario para la Presentación de una Reclamación51164Este formulario se puede usar para procesar su reclamación.Este formulario no está disponible para llenar en línea.Ver este formulario en formato de PDF.Este formulario no se puede completar por teléfono.
Formulario para Solicitar Servicio18397Use este formulario para cambiar su dirección u otra información personal, cambiar su beneficiario o para efectuar otros cambios relacionados con su póliza.Este formulario no está disponible para llenar en línea.Ver este formulario en formato de PDF.Este formulario no se puede completar por teléfono.
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Privacy Policy
"Colonial Supplemental Insurance" and the logo, separately and in combination, and "for what happens next" are service marks of Colonial Life & Accident Insurance Company.

Colonial Supplemental Insurance products are underwritten by Colonial Life & Accident Insurance Company. Coverage has exclusions and limitations that may affect benefits payable. Coverage may vary by state and may not be available in all states. See your representative for complete details. Colonial Supplemental Insurance is the marketing brand of Colonial Life & Accident Insurance Company.