Forms and documents

Select the name of the form or document you would like to view or print. It will open in a new browser window. You may then print the piece by clicking the print button in the icon bar, above the form.

Forms

Enrollment form (pdf)
Complete this form to enroll for accident coverage
Portability form (pdf)
Request to continue all or portion of your in-force insurance.
Termination form (pdf)
Complete this form to terminate your accident coverage

  

Documents

Group Accident Certificate of Insurance Effective 01/01/2022 (pdf)
Details about your group accident insurance plan
Accident Plan Brochure Effective 01/01/2022 (pdf)
Updated information about accident insurance
Accident Plan Brochure Effective 01/01/2023 (pdf)
Information about accident insurance
Identity Theft from Generali Global Assistance (pdf)
General information about identity theft resources
How to file a voluntary claim (pdf)
Information about filing a voluntary claim
Accident insurance premium remittance statement (xlsx)
Use this spreadsheet to quickly calculate your monthly accident insurance premium statement to Securian Financial