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Agility Forms

TitlePurposeAction
Authorization to Release Health-Related InformationAuthorize The Standard to release dental and/or vision insurance information to a designated recipient.Download
Beneficiary Designation Form (All states except NY) - AgilityUse this form to designate beneficiaries for an insurance plan issued in all states except New York (Agility only).Download
Beneficiary Designation Form (NY) - AgilityUse this form to designate beneficiaries for an insurance plan issued in the state of New York (Agility only).Download
Dental ClaimUse this form to report a treatment plan and to initiate a dental claim.Download
Life Claim Packet (All states except NY) - AgilityUse this packet to file a claim for a Life insurance plan issued in all states except New York (Agility only).Download
Life Claim Packet (NY) - AgilityUse this packet to file a claim for a Life insurance plan issued in the state of New York (Agility only).Download
Long Term Disability Claim Packet (All states except NY) - AgilityUse this packet to file a claim for a Long Term Disability plan issued in all states except New York (Agility only).Download
Long Term Disability Claim Packet (NY) - AgilityUse this packet to file a claim for a Long Term Disability plan issued in the state of New York (Agility only).Download
Short Term Disability Claim Packet - AgilityUse this packet to file a claim for a Short Term Disability plan in all states except New York (Agility only).Download
Request for Group Life Conversion MaterialsUse this form to convert group life insurance coverage to an individual life insurance policy.Download
VSP Vision Out of Network ClaimUse to request out of network eye care expense reimbursement.Download
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