Get Download Form #101499 - Colonial Life

Filling out the Download Form #101499 for Colonial Life is an essential task for submitting your claim. This guide will walk you through each section of the form, providing detailed instructions to ensure you complete it accurately and efficiently.

Follow the steps to successfully complete your form

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Complete the header section with your name and the number of pages being submitted. Indicate if you are mailing your submission or faxing it.
3. Provide the required information about your medical condition, including documentation, diagnosis codes, and signed authorization.
4. In the optional service release agreement section, initial next to the services you permit Colonial Life to perform on your behalf.
5. Indicate the type of claim you are submitting by checking the appropriate box for either hospital confinement or outpatient surgical procedure.
6. Fill out personal information for both the claimant and policy owner, including their names, birth dates, social security numbers, and contact information.
7. If applicable, provide the hospital’s or outpatient facility’s name and address, along with the admitting diagnosis or ICD9 code.
8. Review your completed form for accuracy, ensuring all required fields are filled out, and that you have signed and dated where necessary.
9. Once all fields are satisfactorily completed, you can save changes, download a copy, print the form, or share it as needed.

Complete your documents online today for a smoother claims process.