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Find the claim and service forms you need for your VoyaTM Employee Benefits insurance policies. 

Note: These forms are in PDF format. In order to open, view or print these forms you will need to have Adobe Acrobat Reader installed on your computer. This is available with a free download from the Adobe Systems website. When printing multiple-page documents, please use the 2-sided option whenever possible.

Compass Accident Insurance Claims+

There are different types of Accident insurance policies available. Before selecting a claim form please review your certificate and riders to ensure you are selecting the correct form.

To submit a Compass Accident Insurance Claim:

  1. Please print the Accident Insurance Claim form below. The Consumer Privacy Notice is attached.
  2. Note: If your employer has submitted enrollment data electronically, the Employer form below does not need to be completed.
  3. Submit the completed and signed form(s) to the address shown at the top of the form, along with any other required information such as itemized bills.

To submit a Wellness Benefit Rider Claim:

  1. Please print the Wellness Benefit Claim form below. The Consumer Privacy Notice is attached.
  2. Submit the completed and signed form to the address shown at the top of the form.
Accident Insurance Claims (Non-Compass)+

There are different types of Accident insurance policies available. Before selecting a claim form please review the certificate and riders to ensure the correct form is used.

To submit an Accident Insurance Claim (Non-Compass):

  1. Please print the Accident Insurance Claim form below. The Consumer Privacy Notice is attached.
  2. Note: If you are submitting a disability claim under the Off Job Accident Disability Income Rider, your attending physician will also need to complete and sign the Physician's Disability Statement (section 4) on page 3. Your employer will need to complete and sign the Employer's Statement (section 5) on page 3.
  3. Submit the completed and signed form to the address shown at the top of the form, along with any other required information such as itemized bills.

To submit a Wellness Benefit Claim:

  1. Please print the Wellness Benefit Claim form below.  The Consumer Privacy Notice is attached.
  2. Submit the completed and signed form to the address shown at the top of the form.
Compass Critical Illness Insurance Claims+

Note: Critical Illness is known as Specified Disease insurance in some states.

There are different types of Critical Illness (or Specified Disease) insurance policies available. Before selecting a claim form please review your certificate and riders to ensure you are selecting the correct form.

To submit a Critical Illness (or Specified Disease) Insurance Claim, please print the following forms below:

  1. Compass Critical Illness (or Specified Disease) Claim form. The Consumer Privacy Notice is attached.
  2. Attending Physician's Statement of Compass Critical Illness (or Specified Disease).
  3. Authorization to Release Information.
  4. Critical Illness (or Specified Disease) Claim – Employer form. Note: If your employer has submitted enrollment data electronically, this form does not need to be completed.

Submit the completed and signed claim form, attending physician's statement and authorization form to the address shown at the top of the form.

To submit a Wellness Benefit Rider Claim:

  1. Please print the Critical Illness (or Specified Disease) Wellness Benefit Claim form below. The Consumer Privacy Notice is attached.
  2. Submit the completed and signed form to the address shown at the top of the form.
Premier and Horizon Critical Illness Insurance Claims+

Note: Critical Illness is known as Specified Disease insurance in some states.

There are different types of Critical Illness (or Specified Disease) insurance policies available. Before selecting a claim form please review your certificate and riders to ensure you are selecting the correct form.

To submit a Critical Illness (or Specified Disease) Insurance Claim, please print the following forms below:

  1. Critical Illness (or Specified Disease) Wellness Benefit Claim form. The Consumer Privacy Notice is attached.
  2. Attending Physician's Statement of Critical Illness (or Specified Disease).
  3. Authorization to Release Information.

Submit the completed and signed claim form, attending physician's statement and authorization form to the address shown at the top of the form.

To submit a Wellness Benefit Rider Claim:

  1. Please print the Critical Illness Wellness Benefit Claim form below. The Consumer Privacy Notice is attached.
  2. Submit the completed and signed form to the address shown at the top of the form.
Compass Hospital Confinement Indemnity Insurance Claims+

Before selecting a claim form please review your certificate and riders to ensure you are selecting the correct form.

To submit a Hospital Confinement Indemnity Insurance Claim, please print the following forms below:

  1. Compass Hospital Confinement Indemnity Claim - Employee Form. The Consumer Privacy Notice is attached.
  2. Attending Physician's Statement of Hospital Confinement Indemnity
  3. Authorization to Release Information
  4. Hospital Confinement Indemnity Claim – Employer form. Note: If your employer has submitted enrollment data electronically, this form does not need to be completed.

Submit the completed and signed claim form, attending physician's statement and authorization form to the address shown at the top of the form.

To submit a Wellness Benefit Rider Claim:

  1. Please print the Wellness Benefit Rider Claim form below. The Consumer Privacy Notice is attached.
  2. Submit the completed and signed form to the address shown at the top of the form.
Voluntary Disability Income Insurance Claims+

There are different types of Disability Income insurance policies available. Before selecting a claim form please review your certificate and riders to ensure you are selecting the correct form.

To submit a claim, please print the following forms below:

  1. Employee's Statement (with Authorization for Release of Health-Related Information)
  2. Attending Physician's Statement
  3. Consumer Privacy Notice

Your employer will need to complete and sign the Claim Notice Employer's Statement.

All completed forms need to be returned to the insurance company at the address shown at the top of each form.

Cancer/Specified Disease Insurance Claims+

(ReliaStar Life Insurance Company of New York ONLY)

There are different types of Cancer/Specified Disease insurance policies available. Before selecting a claim form please review your certificate and riders to ensure you are selecting the correct form. 

To submit a Cancer/Specified Disease Claim, please print the following forms below:

  1. Cancer or Specified Disease Claim Form
  2. Consumer Privacy Notice

You will need to return the completed claim form, an itemized bill from your medical provider and supporting pathology, cytology or radiological reports to the address shown at the top of the claim form.

To submit a claim for a Cancer Screening Benefit, please print the following forms below:

  1. Cancer Screening Claim Form
  2. Consumer Privacy Notice

You will need to return the completed claim form, along with a copy of the itemized bill from your medical provider, to the insurance company at the address shown at the top of the claim form.

Form Name
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Electronic Funds Transfer Form+

If you want to be directly billed for your insurance coverage, you may use the electronic funds transfer (EFT) to have your premium payment withdrawn from one of your bank accounts.

EFT is an option for you if you are being directly billed for the following insurance coverages:

  • Universal Life
  • Whole Life 
  • Horizon Disability Income
  • Critical Illness/Specified Disease
  • Accident
  • Cancer
  • Group Term Life

It's easy to start the automatic EFT program - simply complete these steps:

  1. Complete the Authorization for Electronic Funds Transfer Form below. Note that everyone authorized to draw on the bank account must sign the form. The policy/certificate number(s) to be drawn from this account must be listed.
  2. Attach a voided check.
  3. Return the Authorization for Electronic Funds Transfer form and voided check to the address listed at the top of the form.

If you have any questions about EFT, please call our Customer Service department at (800) 537-5024, Monday through Friday between 9:30 a.m. - 6:30 p.m. Eastern Time.

Service Request Form+

You may use the Service Request Form to request a variety of services including:

  •  change of beneficiary 
  •  change of name 
  •  transfer of ownership 
  •  address change
  •  policy loan request 
  •  cancellation of coverage

The form can be used for the following insurance coverages offered by Voya Employee Benefits:

  • Universal Life
  • Whole Life
  • Accident
  • Critical Illness/Specified Disease
  • Voluntary Disability Income

Submit the completed and signed form below to the address shown at the top of the form, along with any other required information.

VoyaTM Employee Benefits insurance products and services 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 VoyaTM family of companies. Product availability and specific provisions may vary by state.