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.
Allstate - Claim Forms
Allstate Accident Physician's Treatment Claim Form: Download Form
Allstate Group Accident Claim Form (CCS) Download Form
Group Cancer Claim Form: Download Form
Wellness Claim Form: Download Form
Critical Illness Claim Form: Download Form
Policy Service form (ex. address, name, beneficiary changes): Download form
Allstate SHOP Information: Download Brochure
SHOP Claim Form: Download Form
Allstate GIM2 (Group Indemnity Medical): Download Form
Allstate Claims Service Number: 1-800-348-4489
Allstate Policyholder Service Number: 1-800-521-3535
Boston Mutual Life Insurance
Life Insurance: Boston Mutual Claim Form (3) (1)
Manhattan Life (formerly Humana Policies) - Forms & Policies
Texas Life Whole Life Insurance
For Customer Service: 1-800-283-9233 press #2
Cancer Select Plus and TransElite (Universal Life Insurance)
Policy Holder Service Form: Claims for TRANSAMERICA can be filed by calling TRANSAMERICA direct at 1-800-251-7254 or by logging into their site at www.tebcs.com. You will need your policy number in order to log in.
For questions you can call Olde Fayetteville Insurance at 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