American Legacy Association

FORMS

Accidental Death Benefit Claim Form - AcciProtect 100K, OptiProtect+ 5K, OptiSelect+ 5K, and OptiProtect+ 10K only

May, 6 2021

Please follow the instructions on the form for quicker claim processing. Call 800-338-7452 for help in filing your claim. download now

Accidental Medical Benefit Claim Form - Plans OptiProtect+ 5K, OptiSelect+ 5K, and OptiProtect+ 10K Only

June, 18 2021

Please follow the instructions on the form for quicker claim processing. Call 800-338-7452 for help in filing your claim. download now

Cancer Lump Sum Benefit and Limited Specified Disease Benefit for Heart Attack and Stroke (Critical Illness) Claim Form - OptiSelect+ 5K Only

June, 18 2021

Please follow the instructions on the form for quicker claim processing. Call 800-338-7452 for help in filing your claim. download now

Dismemberment & Loss of Sight Benefit Claim Form - Plans AcciProtect 100K, OptiProtect+ 5K, OptiSelect+ 5K, and OptiProtect+ 10K Only

Sep, 7 2021

Please follow the instructions on the form for quicker claim processing. Call 800-338-7452 for help in filing your claim. download now