Submit a Wellness Claim
  
To file your Wellness claim, please complete the information below. You may file for any covered test performed during the last 12 months. To file for tests occurring prior to the previous 12 month period, please submit a completed claim form and attach a copy of the bill indicating the charge and type of test performed.

We will call your medical facility to verify the information provided. However, if the medical provider will not release information over the phone, you will receive a letter from our office asking you to provide additional information. Please allow 14 days for your claim to be processed.

Please Note: The information you enter on the online forms is transmitted to Colonial via e-mail. The transmission is not secure. As a result, the privacy of any Social Security number that you include on an online form cannot be guaranteed. To file your wellness claim by telephone, please call the Policyholder Service Center at 1-800-325-4368. You may submit the loss of life notification form by fax to 1-800-880-9325.


* indicates required fields
Policyholder Information
Policyholder Name *
Address *
City *
State *
Zip Code *

Telephone Number *
(XXX) XXX-XXXX   

Social Security Number
Date of Birth *
(MM/DD/YYYY)   
Policy Number
Date of Test *
(MM/DD/YYYY)   
Type of Test *
Email *
Medical Provider Information
Medical Provider (first and last name) *
Telephone Number *
(XXX) XXX-XXXX   
Address *
City *
State *
Zip Code *
Claimant Information (if other than policyholder)
Claimant
Relationship    Spouse   Dependent
Claimant Social Security Number
Claimant Date of Birth
(MM/DD/YYYY)
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Colonial Life & Accident Insurance Company is a subsidiary of Unum Group
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Colonial Life products are underwritten by Colonial Life & Accident Insurance Company. Coverage has exclusions and limitations that may affect benefits payable. Coverage may vary by state and may not be available in all states. See your representative for complete details. Colonial Life is the marketing brand of Colonial Life & Accident Insurance Company.