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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.

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Form Number Description
Dental | Alliance network
UC-Dep_1208 Dependent Certification
GDFM-1370 Dental Claim form with Alliance network
GDFM-1370 (AZ) AZ Dental Claim form with Alliance network
GDFM-1280 Request and Authorization for Disclosure of Health Info
GDFL-3179 Dental Alliance PPO Flyer
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Dental and Vision | All other networks
XGR/2262 Dental Claim Form
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SunAdvisor®
XGR/647 SunAdvisor Claim Packet
SLF_SA_AUTH_APS SunAdvisor Authorizations & APS
GSTDFL4184 SunAdvisor Advice to Pay flyer
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Enrollment
XGR/2794 DENTAL SLOC EBG Dental Enrollment form
XGR/2794 ML SLOC EBG Multi-Line Enrollment form
XGR/2794 MLD SLOC EBG Multi-Line w/Dental Enrollment form
XGR/2794 Life SLOC EBG Life Only Enrollment form
XGR/2794 Dis SLOC EBG Disability Only Enrollment form
XGR/2794 VMLD SLOC EBG Voluntary Multi-Line w/Dental Enrollment form
XGR/2794 VL SLOC EBG Voluntary Life Only Enrollment form
GMPFM-2560 Refusal of Non-Contributory Coverage
GGFM-3799 (NY) Refusal of Non-Contributory Coverage (NY)
GMPFM-2560 (SLHIC) Refusal of Non-Contributory Coverage (SLHIC)
OOC_CANCER-ONLY Outline of Coverage - Cancer Only
OOC-CI-HSA Outline of Coverage - Critical Illness - HSA
OOC_CI-NON-HSA Outline of Coverage - Critical Illness - Non-HSA
OOC_CI-CANCER-HSA Outline of Coverage - Critical Illness - Cancer - HSA
OOC_CI-CANCER-NONHSA Outline of Coverage - Critical Illness - Cancer - Non-HSA
GGFM-3799 (SLHIC NY) Refusal of Non-Contributory Coverage GGFM-3799 (SLHIC NY)
SLF_ENROLL_INSTR_SP SLF Enrollment Instructions - Spanish
XGR/823 Life/AD&D-Only Enrollment Form (non-contrib)
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Evidence of Insurability
GLFM-2247 HIPAA Authorization for Medical Underwriting
XNYGR/1480 EOI Application (NY)
GLFM-2055 EOI Cover Page Instructions
GMPAP-3040 (CT) Evidence of Insurability application (CT)
GMPAP-3040 (MO) EOI Application (CI Only) (MO)
GMPHO-ER-200 EOI and Online-EOI Handout for Employers
XGR/1497 EOI Application (VT)
XGR/1467 EOI Application (FL)
GMPAP-3040 (ME) - SLOC EOI Application (ME) - SLOC
XGR/1470 EOI Application (non-CI) (CA)
XGR/1476 EOI Application (MA) - Life Only
GMPAP-3040 (KS) EOI Application (KS)
XGR/1472 EOI Application (OR)
GMPAP-3040 EOI Application (All states except what's list individually)
GESVHO-ER-3320 New for Sun Life Connect
GMPAP-3040 (CA) EOI Application (CI only) (CA)
GMPAP-3040 (FL) EOI Application (CI only) (FL)
GMPAP-3040 (NH) EOI Application (CI only) (NH)
GMPAP-3040 (OR) EOI Application (CI only) (OR)
GMPAP-3040 (UT) EOI Application (CI only) (UT)
XGR/1466 EOI Application (For use in: MO, NH, PR, and UT)
GMPAP-3040 (GA) EOI Application (GA)
GMPAP-3040 (ID) EOI Application (ID)
GMPAP-3040 (IN) EOI Application (IN)
GMPAP-3040 (KY) EOI Application (KY)
GMPAP-3040 (MA) Health Only EOI Application (MA) Health Only
GMPAP-3040 (MD) EOI Application (MD)
GMPAP-3040 (ME) - SLHIC EOI Application (ME) - SLHIC
GMPAP-3040 (MN) EOI Application (MN)
GMPAP-3040 (MT) EOI Application (MT)
GMPAP-3040 (NE) EOI Application (NE)
GMPAP-3040 (NJ) SLHIC EOI Application (NJ) SLHIC
GMPAP-3040 (NJ) SLOC EOI Application (NJ) SLOC
GMPAP-3040 (NM) EOI Application (NM)
GMPAP-3040 (OH) EOI Application (OH)
GMPAP-3040 (RI) EOI Application (RI)
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FMLA
XGR/2255 Mandatory Notice (NJ) - SLHIC (U.S.)
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Long Term Disability
PRWP-2323 Long Term Disability Whitepaper
XGR/1640 Long Term Disability Claim - Employer's Statement
XGR/351 LTD Conversion Notice
XGR/464 LTD Conversion Application
XGR/1641 Long Term Disability Claim - Employee's Statement
GLTDBCH-3131 Sample Group LTD Policy
GVCDFM-3042 Customized Disability Employer Statement
GVCDFM-3043 Customized Disability Employee Statement
GDIFL-4056 Statuatory plans at a glance
XGR/1642 Long Term Disability Claim - Attending Physician's Statement
GDISI-4202 Return-to-work Sales Strategies
GVCDFM-3044 Customized Disability Attending Physician Statement
LOOK-BACK_FORM Look-Back Percentage Form
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Life and AD&D
GR/2284-SPANISH Group Life Conversion Kit-SPANISH
GLBCH-3129 Sample Group Life Policy
GLFM-1233 Beneficiary Designation
GLFM-2055 EOI Cover Page Instructions
XGR/2361 Group Death Claim Packet
GLFM-1635 Conversion and Portability Notice
GLPK-EE-164 Life insurance conversion: Solutions for employees
GMPFM-2690 Voluntary Portability Notice
GLFM-4147 Life Conversion Notice (NY and non-NY)
XGR/1548 Group Life Benefits Claim Packet
GLWP-690 Discrimination and taxation of group term life benefits whit
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Miscellaneous
GCIFM-2831 Critical Illness Employee Statement
GCIFM-2830 Critical Illness Attending Physician Statement
GVACPK-4179 Accident Continuation Kit
GDFM-1280 Request and Authorization for Disclosure of Health Info
GCIFM-2939 Wellness Benefit Reimbursement
XGR/1385 Authorization (Complies with HIPAA)
XGR/2694 Privacy Notice SLOC
XGR/2818 Group W-2 Tax Reporting Sevice Agreement
XGR/1277 ERISA Booklet Endorsement
GGFM-3613 Employer Notice INDIANA State Guaranty
GVACPK-3542 Accident Portability Kit
GCIPK-4011 Critical Illness HSA Continuation Kit
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Premium/Billing
GMPFM-1512 Summary Statement
GSLFM-1519 Stop-Loss Summary Statement
XGR/1457 List Billing Change Form
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Short Term Disability
GSTDFM-2718 STD Claim HIPAA Authorization
GMPAP-3430 Voluntary Portability Application
GSTDBCH-3130 Sample Group STD Policy
GMPFM-2690 Voluntary Portability Notice
GVCDFM-3042 Customized Disability Employer Statement
GVCDFM-3043 Customized Disability Employee Statement
XGR/2603 Short Term Disability Claim Packet
Disab_Auth_APS STD Employee Stmt Authorization and APS
GVCDFM-3044 Customized Disability Attending Physician Statement
SLF_Auth_APS STD Authorization and APS
LOOK-BACK_FORM Look-Back Percentage Form
LOOK-BACK_FORM_NY Look-Back Percentage Form (NY)
GSTDFL4184 SunAdvisor Advice to Pay flyer
GSTDBCH-3229 Voluntary STD Portability Kit
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Stop-Loss
XGR/467 Aggregate Monthly Claims Report
XGR/437 Specific Stop-Loss Claim/50% Notice
XGR/1348 Stop-Loss Simultaneous Reimbursement Request Form
XGR/1679 Stop-Loss Direct Deposit Authorization
2012SLPolicySLOC 2012 Stop-Loss Policy Sample SLOC
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State Guaranty Notices
XGR/2130 Employer Notice - ALASKA State Guaranty
XGR/2131 Employer Notice ARKANSAS State Guaranty
XGR/2132 Employer Notice CALIFORNIA State Guaranty
XGR/2133 Employer Notice COLORADO State Guaranty
XGR/2134 Employer Notice WASHINGTON DC State Guaranty
XGR/2135 Employer Notice HAWAII State Guaranty
XGR/2136 Employer Notice ILLINOIS State Guaranty
XGR/2138 Employer Notice LOUISIANA State Guaranty
GGFM-3613 Employer Notice INDIANA State Guaranty
XGR/2137 Employer Notice KANSAS State Guaranty
XGR/2139 Employer Notice MARYLAND State Guaranty
XGR/2140 Employer Notice MINNESOTA State Guaranty
XGR/2141 Employer Notice MISSOURI State Guaranty
XGR/2142 Employer Notice MISSISSIPPI State Guaranty
XGR/2143 Employer Notice MONTANA State Guaranty
XGR/2144 Employer Notice N CAROLINA State Guaranty
XGR/2145 Employer Notice N DAKOTA State Guaranty
XGR/2146 Employer Notice NEW HAMPSHIRE State Guaranty
XGR/2147 Employer Notice NEW JERSEY State Guaranty
XGR/2148 Employer Notice NEVADA State Guaranty
XGR/2149 Employer Notice OHIO State Guaranty
XGR/2150 Employer Notice OKLAHOMA State Guaranty
XGR/2151 Employer Notice RHODE ISLAND State Guaranty
XGR/2152 Employer Notice S DAKOTA State Guaranty
XGR/2153 Employer Notice TENNESSEE State Guaranty
XGR/2154 Employer Notice TEXAS State Guaranty
XGR/2155 Employer Notice UTAH State Guaranty
XGR/2156 Employer Notice WEST VIRGINIA State Guaranty
XGR/2157 Employer Notice WYOMING State Guaranty
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