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Family & Medical Leave Act (FMLA) HR Handbook. AE-6009. Hospital Indemnity Coverage Certification of Medical, Hospital, and surgical coverage. CS-1109. Letter of Medical Necessity For Flexible Spending Accounts. 6653-03. Medical Authorization Form (HIPAA) - Arizona. 6720-03-CA. Medical Authorization Form (HIPAA) - California.
Access common forms. We offer a variety of downloadable forms to make it easy to do business with us. To quickly find what you need, search our forms library by form number or keyword.
The repository provides instant access to legal and compliance documents required for enrolling in Unum products. Carefully select each product and state as required.
For more information on how to join our growing network of dental professionals, contact one of our Provider Relations Representatives at 1-800-937-3400 or fill in the form below: Specialty Type. Contact. 1-800-937-3400. Mon - Fri 8:00 am - 5:00 pm PST. contact@unumdentalhmo.com.
Group Dental Claim Form: CL-1234: Group Life - Disability Benefit Claim Form: CL-1310: Life Accelerated Benefit Claim Form: NY 1474-96: Portability Group Life/AD&D Claim Form - New York: NY1343-99: Short Term Disability Claim Form - Required For New Jersey Employees: MK-1252: Submitting a Disability Claim employee flyer: CL-1252: Unum DHMO ...
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When should you use this claim form? Use this claim form to apply for disability benefits with Unum. This form should be used for the following types of claims only: • Short Term Disability • Voluntary Benefits Disability
