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GROUP ACCIDENT, CRITICAL ILLNESS/SPECIFIED DISEASE & HOSPITAL INDEMNITY CLAIM FORM Employee/Member/Claimant Statement Hartford Life and Accident Insurance Company In furnishing this form, The Hartford
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Obtain the necessary forms for filling out the group accident critical illness specified coverage.
02
Fill in personal information such as name, address, contact details, and date of birth.
03
Provide information about the group coverage, including policy number and coverage details.
04
Specify the type of accident or critical illness being claimed for and provide any supporting documentation.
05
Review the completed form for accuracy and completeness before submitting it to the insurance provider.

Who needs group accident critical illnessspecified?

01
Employers who want to provide additional financial protection to their employees in case of accidents or critical illnesses.
02
Employees who want to have insurance coverage for specific critical illnesses or accidents that may occur.
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Group accident critical illness specified refers to a type of insurance coverage that provides financial benefits to members of a group (such as employees in a company) in the event that they suffer from a critical illness resulting from an accident.
Employers or the group policyholders are typically required to file the group accident critical illness specified with the relevant insurance authority or regulatory body.
To fill out group accident critical illness specified, collect all necessary information about the group members, including personal details, coverage options, and the types of critical illnesses covered, then complete the designated forms provided by the insurance company.
The purpose of group accident critical illness specified is to provide financial protection and support for individuals in the event of serious health issues resulting from an accident, ensuring that they can receive necessary treatment without facing crippling financial burdens.
Information that must be reported includes the names of the covered individuals, their personal identification details, types of coverage selected, and any relevant medical history that may affect eligibility.
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