This program is underwritten by New York Life Insurance Company,
New York, NY 10010 on policy form GMR-FACE

Direct form access

Claim Form

Filing a claim?  We can help!

If it becomes necessary for you to file a claim under your coverage, be assured that we will help you through the process - each step of the way.  We encourage you to call or email us - at any time throughout the process - if you have any questions or need our assistance.  New York Life is deeply committed to reviewing your claim fairly and on a timely basis.

To start your claim, simply complete the claim form (including the portions to be completed by your physician and your employer), print out the form, sign it (including a signature from your physician and employer), then return the form to our office.  New York Life will also need your last 3-years of tax returns (with supporting schedules, including copies of your W2s and/or 1099s), along with a copy of your birth certificate.  Once we receive your claim form and the accompanying information, we will let you know that we've received it, and give you direction on what happens next.  Again, please get in touch with us if you have any questions.

Please click HERE for your claim form.

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