Hospital Indemnity Claims: What to Submit

When filing a hospital indemnity insurance claim, you will need to provide the following documentation:

• Statement of Insured, completed via online claim filing or paper claim form
• Itemized Bills with diagnoses for all inpatient confinement, imaging, and advanced studies claims
• Medical Records or Office Notes for treatment related to critical illness or accident claims

We may also need:

• Authorization to Disclose Information Including PHI: This form gives us authorization to get records from your medical provider(s) and others who may hold information necessary for us to review your claim. Upload the form via your online account, or mail or fax it.