Service Request/ Quick Forms

In an effort to assist in simplifying your employees’ benefit needs Benefit Specialists has provided the most often requested forms in a downloadable format below. 

If you do not see the appropriate form below please fill out a service request with the information regarding the type of form and company you are looking for and we will respond to you within 24 hours.

Please feel free to contact Benefit Specialists through the service request tool below if you have a question or would like more information on a specific carrier, product or service.

Benefits Specialists would be happy to help you and we will promptly reply to your request within 24 hours. 

Please note that fields designated with a * are required information and must be supplied before submitting.

Quick Forms

Avesis
Avesis claim form	Down load
Avesis Employee App	Down load
Companion Life
Companion Life Enrollment Form	Down load
Agent Claims Authorization	Down load
Fort Dearborn Life
Application with evidence of insurablity	Down load
Beneficiary form- English	Down load
Lincoln Financial
Evidence of Insurability	Down load
Life Claim Form	Down load
STD Claim Form(Omaha)	Down load
LTD Claim Form (Omha)	Down load
Beneficiary Designated Form	Down load
EOI form	Down load
Midland National Life
Policy Change, reinstatement, conversion form	Down load
Midland bank draft	Down load
Midland beneficiary form	Down load
Midland Service form	Down load
Pioneer Mutual (One America)
Bank Draft Authorization	Down load
Pioner Mutual Bene. Change form	Down load
Death Claim form	Down load
Pioneer general service form	Down load
Reliance Standard Life
Reliance Beneficiary form	Down load
Reliance Integrated DI Claim Form	Down load
VIP LTD Conversion Form	Down load
Spirit Dental
Spirit Dental Employee Enrollment Form	Down load
Spirit Dental employee FAQ	Down load
Spirit Dental Employer FAQ	Down load
Spirit Dental Change Form	Down load
Spirit Dental Bank ACH	Down load
Standard Insurance of Oregon
Consolidated Disability claim packet 2047 for ND	Down load
Evidence of Insurability	Down load
Beneficiary form for ND	Down load
1794 Life Claim Packet for ND	Down load
UNUM Life
Unum reinstatement and change app	Down load
Bank Draft form	Down load
Unum evidence of insurablitiy form	Down load
Unum claim form	Down load
Non Disabling Injury claim form	Down load
LTC Continuation Notice	Down load
Unum Beneficiary form	Down load

Primary Companies with Links:

- Avesis   www.avesis.com
How to use the vision benefits
- Fort Dearborn Life   www.fdl-life.com
- Medica   www.medica.com
- Met Life   www.metlife.com 
For employees  - www.metlife/mybenefits.com
- Pioneer Mutual/One America    www.oneamerica.com
- Reliance Standard   www.reliancestandard.com
- Standard Insurance of Oregon   www.standard.com
- UNUM   www.unum.com
- Spirit Dental  www.spiritdental.com
- Illinois Mutual   www.illinoismutual.com
- Purchasing Power   www.purchasingpower.com
- Unitrin Direct      www.udpreferred.com