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Customer Service Forms
Claim Forms

Need help determining which benefit claim package you need? More

Wellness Benefit

Benefit for certain wellness-type exams and procedures; such coverage provided under many different types of policies and riders

Disability Income Benefit

Benefit for being disabled, as defined by the contract; such coverage generally provided under a DI policy or DI rider attached to another type of policy

Critical Illness Benefit

Benefit for diagnosis of a specified critical illness (such as but not limited to cancer, heart attack or stroke) or for a covered procedure; such coverage generally provided under a CI policy or CI rider attached to another type of policy

Accident Expense Benefit

Benefit for accident-related medical treatments; such coverage generally provided under an Accident Expense policy

Hospital Indemnity Benefit

Benefit for hospital confinement and possibly associated medical treatments; such coverage generally provided under an HI policy

Cancer Expense Benefit

Benefits specifically for the care and treatment of cancer; such coverage is generally provided under a Cancer Expense Policy

Death Benefit

Benefit for the death of an insured person; such coverage generally provided under a life insurance policy

For policyholders of Assurity Life Insurance Company of New York, please call (844) 401-7585 to obtain necessary forms.

For policyholders of Assurity Life Insurance Company, use the selection boxes below to select the benefit for which you are filing a claim and the claimant’s state of residence.



Form Name
Hurricane Impact
IMPORTANT NOTICE TO CUSTOMERS AFFECTED BY RECENT HURRICANES More
Special Notice

At Assurity, our hearts go out to all those impacted by the recent hurricanes. As a company dedicated to helping people through difficult times, one of our primary goals is to accommodate the needs of our customers.
 
If you are a resident of affected areas of Texas, Georgia, Florida or Louisiana and you need special consideration as a result of these storms, please contact Customer Connections at 1-800-869-0355, Ext. 4279.

Office Hours
Assurity’s hours are Monday through Friday, 7 a.m. to 5 p.m., Central Time.

For policyholders of Assurity Life Insurance Company:
 
Client Services
(800) 869-0355, Ext. 4279
Fax: (888) 255-2060
Claims Reporting and Services
(800) 869-0355, Ext. 4484
Fax: (800) 869-0368
Assurity at Work® Employer and Worksite Case Support
(866) 289-7337, Ext. 4210
For policyholders of Assurity Life Insurance Company of New York:
Client Services
(844) 401-7585
Fax: (888) 255-2060
Claims Reporting and Services
(844) 401-7585
Fax: (800) 869-0368
Mailing and Contact Information
Corporate and Administrative office:
Mailing address

Assurity Life Insurance Company

P.O. Box 82533
Lincoln, NE 68501-2533
Corporate and Administrative office:
Shipping address

Assurity Life Insurance Company

2000 Q Street
Lincoln, NE 68503
Corporate office switchboard

(402) 476-6500

Corporate office Fax

(402) 437-4395

New York Office
121 State Street
Albany, NY 12207
(844) 401-7585

All correspondence should be mailed to Assurity's corporate and administrative office at:

P.O. Box 82533
Lincoln, NE 68501-2533
Secure Email

We provide a secure email solution to help ensure the information you share with us is seen only by us and not used illegally. Please help us keep your information secure by submitting all emails with personal information in an encrypted format using the secure ZixCorp email solution (below). Non-public personal information includes, but is not limited to, Social Security and other tax identification numbers, passwords, and health and financial information.

Email addresses for our various customer service areas are shown on the Contact page.

So that your personal information is not used illegally, we've implemented the ZixCorp secure email solution to provide an encrypted service that prevents any message you send from being opened by anyone outside our office.

Learn More