Find a form

If you’re covered for group life, disability, or dental insurance, or if you administer group benefits, you can access a variety of frequently used forms.

I’d like a form for:

Form Number Description
Dental | Alliance network
GDFM-1370 (SLHIC NY) NY Dental Claim form with Alliance network - SLHIC NY
HIPAA-Notice-Privacy HIPAA Notice of Privacy Practices
GDFM-1280 Request and Authorization for Disclosure of Health Info
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Dental and Vision | All other networks
XGR/2262 Dental Claim Form
HIPAA-Notice-Privacy HIPAA Notice of Privacy Practices
XGR/2329 Dental Claim-N.Y. State School Trust
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Enrollment
GGFM-3799 (SLHIC NY) Refusal of Non-Contributory Coverage GGFM-3799 (SLHIC NY)
GLFM-3702 (SLHIC NY) Beneficiary Designation (SLHIC NY)
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Evidence of Insurability
XNYGR/1480 EOI Application (NY)
GVFM-3637(SLHIC NY) EOI Application - CI (NY)
GLFM-2247 SLHIC (NY) HIPAA Authorization for Medical Underwriting - SLHIC NY
GLFM-2055 (NY) EOI Cover Page Instructions (NY)
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Long Term Disability
GLTDFM-3556 (SLHIC NY) LTD Claim - Employer's Statement (SLHIC NY)
GLTDFM-3557 (SLHIC NY) LTD Claim - Employee's Statement GLTDFM-3557 (SLHIC NY)
GLTDFM-3558 (SLHIC NY) LTD Claim - Attending Physician's Stmt (SLHIC NY)
GLTDFM-3085 Social Security / Retirement Status
XNYGR/1144 (SLHIC NY) Info Request: Training/Education (NY)
GLTDAP-3475 SLHIC NY LTD Conversion Application SLHIC (NY)
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Life and AD&D
GLFM-3316 SLHIC (NY) Group Life Benefits Claim Packet (NY)
GLFM-3527 SLHIC (NY) Group Death Claim Packet - SLHIC (NY)
GLFM-3702 (SLHIC NY) Beneficiary Designation (SLHIC NY)
GMPFM-2690 (NY) Voluntary Portability Notice (NY)
GLFM-2247 SLHIC (NY) HIPAA Authorization for Medical Underwriting - SLHIC NY
GLFM-2055 (NY) EOI Cover Page Instructions (NY)
GLFM-4147 Life Conversion Only Notice (NY and non-NY)
GLPK-EE-164 Life insurance conversion: Solutions for employees
GLFM-1635 Conversion and Portability Notice (NY and non-NY)
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Miscellaneous
GLTDFM-3762 (SLHIC NY) FICA Match Service Agreement GLTDFM-3762 (SLHIC NY)
GLTDFM-3764 (SLHIC NY) Group FICA Match/Tax Reporting Service Agreement (SLHIC NY)
GDFM-1280 Request and Authorization for Disclosure of Health Info
GLTDFM-3763 (SLHIC NY) Group W-2 Tax Reporting Service Agreement (SLHIC NY)
GLTDFM-3765 (SLHIC NY) DBL W-2 Form (SLHIC NY)
GLGL-3797 (SLHIC NY) Authorization (Complies with HIPAA) GLGL-3797 (SLHIC NY)
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Premium/Billing
GLFM-5149 (NY) Premium Statement for Step-Rates (NY)
GVFM-3798 (SLHIC NY) Summary Statement (SLHIC NY)
GGFM-3818 (SLHIC NY) List Billing Change Form (SLHIC NY)
GSLFM-3813 (SLHIC NY) Stop-Loss Summary Statement (SLHIC NY)
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Short Term Disability
GSTDFM-5298 (SLHIC NY) Short Term Disability Claim - Employer Statement (SLHIC NY)
GSTDFM-5299 (SLHIC NY) Short Term Disability Claim - Employee Statement (SLHIC NY)
GSTDFM-5300 (SLHIC NY) Short Term Disability Claim - Attending Physician (SLHIC NY)
GMPFM-2690 (NY) Voluntary Portability Notice (NY)
DB 450 DBL Claim Form - NY
GMPAP-3430 (NY) Voluntary Portability Application (NY)
HCPS DB 450 Stand Alone DBL Part B Health Care Provider's Statement - NY
GSTDFM-5330 (NY) STD Reimbursement Agreement (NY)
GSTDFM-2718 (NY) STD Telephonic Claim HIPAA Authorization (NY)
GLTDFM-5418 SLHIC NY Look-Back Percentage Form (NY)
GVSTDFM-3368 (NY) Portable Voluntary STD Claim Statement (SLHIC NY)
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Stop-Loss
GSLFM-4785 (SLHIC NY) Specific Stop-Loss Claim/50% Notice (SLHIC NY)
GSLFM-3815 (SLHIC NY) Aggregate Monthly Claims Report (SLHIC NY)
GSLFM-4786 (SLHIC NY) Stop-Loss Direct Deposit Authorization (SLHIC NY)
GSLFM-3813 (SLHIC NY) Stop-Loss Summary Statement (SLHIC NY)
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SunAdvisor®
GSTDFM-6167 (SLHIC NY) SunAdvisor Claim Packet - Employer (SLHIC NY)
GSTDFM-6168 (SLHIC NY) SunAdvisor Claim Packet - Attending Physician (SLHIC NY)
GSTDFM-6185 (SLHIC NY) SunAdvisor® Claim Packet - HIPAA and Privacy (SLHIC NY)
GSTDFM-6371 (NY) Service Agmt-Full Service Advice to Pay w/Benefit Calc (NY)
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Claim forms for NY coverage prior to 2014

Use these Life, Disability, or Stop-Loss claim forms if you’ve had Sun Life coverage prior to 2014 and your claim is for a date prior to 5/1/2014.

If your Sun Life coverage began on 2014, or if you claim is for a date after 5/1/14, use the forms to the left.