Forms & Handouts
Claim Forms, Enrollment Documents, Helpful Flyers & More
Forms
The list below includes commonly accessed forms that can be downloaded and printed out for your convenience. Please don’t hesitate to contact us if you need assistance.
New Group Enrollment
AHPT Forms
- Self-Pay Claim Form
- Qualifying Event Form
- HIPAA PHI Release Form
- UNUM Voluntary Life Enrollment Form
- Personal Health Questionnaire
- UNUM Voluntary Life/ADD EOI Form
- Group Health Questionnaire
- Portability Form
- Notice of Privacy Practices
- Conversion Form – TX
- Kempton Group General Privacy Policy
- Life Insurance Claim Information
Member Handouts
The list below includes helpful informational and marketing handouts that can be downloaded and printed out for your convenience.
AHPT Member Handouts
- KPPFree™ Breast Cancer Awareness Month
- AHPT Provider Intro Letter for Choice Plans
- KPPFree™ Flyer
- ScriptSourcing Enrollment
- KPPFree™ Know Before You Go
- ScriptSourcing $0 Flyer
- KPPFree™ Cash Price Agreement Flyer
- ScriptSourcing Easy Button Online
- Vision Flyer
- HeyHealthy Flyer (NEED LINK)
- Dental Flyer
- FHS Flyer (NEED LINK)
- AHPT Provider Intro Letter
Reference Based Pricing
Leaders Life & Unum Handouts
- Leaders Life Flyer
- Group Long Term Disability Highlight Sheet
- Leaders Life Accident Insurance Brochure
- Group Voluntary Life Employee Education Highlight Sheet
- Leaders Life Accident Insurance Application
- Unum Group Term Life Portability and Conversion Brochure
- Leaders Life Term to 100 Application
- Work-Life Balance Employee Assistance Program – Flyer
- Leaders Life Term to 100 Brochure
- Leaders Life AM Best
- Work-Life Balance Employee Assistance Program – Wallet Card
- Group Life Employee Education Highlight Sheet