Insurance Forms & Resources

As an Olde Fayetteville Insurance client, please feel free to take advantage of these resources to find your insurance forms. We added some of the most requested forms so the information you need is right at your fingertips. Please know that you can contact our office if you have any questions about the insurance forms below.


Aflac - Critical Illness & Accident

Allstate - Claim Forms

Boston Mutual Life Insurance

Humana - Forms & Policies


                 Workplace Voluntary Disability Claim Form

                 Continuing Disability Claim Form

Texas Life Whole Life Insurance

For Customer Service: 1-800-283-9233 press #2

 Protective Life Insurance Company (universal life and term)

Policy holder Service Form: Download Form

For Forms and Customer Service: Local 1-910-483-6210

The HealthPlan (Dental, Vision, Short Term Disability and Flexible Spending Accounts for CCS Employees)

FSA Customer Service- 1-866-347-3640

FSA Claim Form - Download here

Dental, Vision and Short Term Disability Customer Service- 1-910-484-1819

Click here for Contracted Dental Practices

For Dental and Vision Reimbursements,  members can mail the itemized statement and proof of payment into the following address.

The Health Plan

52160 National Road East

St. Clairsville, OH 43950