New York policyholders find claim forms here.

How to File a Claim

To file a claim, simply select the appropriate claim form for your specific product and mail or fax it to us at the address below. It’s that simple.
  1. Download the form.
  2. Fill it out.
  3. Send it in.
 

File a claim for one of the products below. Simply complete the appropriate form, sign and mail or fax it to the address listed below.

Life insurance        Critical illness and cancer 

Accident                 Disability 

Dental                     Hospital confinement

Wellness Benefit     Health Screening Benefit

 

NOTICE: As part of our ongoing efforts to provide the very best in customer service, Trustmark Voluntary Benefit Solutions is introducing a new claim form that will need to be completed to claim future benefits under a Wellness or Health Screening Rider.  The use of this form is part of an improved claims process that will help us expedite the turnaround time on claims handling, providing benefits to our customers faster.

 

Life insurance

Download a PDF claim form for:

 

To:

Trustmark Insurance Company
Attn: Life Claims
100 North Parkway, Suite 200
Worcester, MA 01605
Fax: 508.853.0310

Contact us.

 

Critical illness and cancer

Download a PDF claim form for:

To:
Attn: MAWORKSITE
Trustmark Insurance Company
100 North Parkway, Suite 200
Worcester, MA 01605
Fax: 508.853.2867

 

For a Health Screening Rider claim, please submit the following form to Trustmark

To:
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.  
Fax: 508.471.3208

 

Health Screening Rider

If you have a health screening rider (HSR), the covered health screen tests may include the following procedures:

 

• Low-dose mammography      • Pap smear for women over age 18
• Flexible sigmoidoscopy      • Hemocult stool sample
• Colonoscopy      • Prostate specific antigen (for prostate cancer)
• Stress test on a bicycle or treadmill      • Fasting blood glucose test
• Blood test for triglycerides      • Serum cholesterol test to determine levels of HDL/LDL
• Bone marrow testing      • Breast ultrasound
• CA 15-3 (blood test for breast cancer)      • CA 125 (blood test for ovarian cancer)
• CEA (blood test for colon cancer      • Serum protein electrophoresis (blood test for myeloma)
• Chest x-ray      • Thermography

 

 

 

 

 

 

 

 

 

 

This is a brief description of benefits and is not a contract. Please consult your coverage documents for specific covered tests and limitations. Benefit amounts, covered tests and number of payable benefits per year may vary by state. A waiting period may apply, which may vary by state. Only tests performed after the applicable waiting period qualify for reimbursement. Benefits are supplemental and are not intended to cover all medical expenses.

 

 

Contact us.

Accident

Download a PDF claim form for:

To:
Attn: MAWORKSITE
Trustmark Insurance Company
100 North Parkway, Suite 200
Worcester, MA 01605
Fax: 508.853.2867

 

For a Wellness Benefit claim, please submit the following form to Trustmark:

To:
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.  
Fax: 508.471.3208

 

Wellness

If you have a wellness rider, the covered screening exams may include the following procedures:

 

• Low-dose mammography      • Pap smear for women over age 18
• Routine physicals      • Hemocult stool sample
• Colonoscopy      • Prostate specific antigen (for prostate cancer)
• Stress test on a bicycle or treadmill      • Fasting blood glucose test
• Blood test for triglycerides      • Serum cholesterol test to determine levels of HDL/LDL
• Bone marrow testing      • Breast ultrasound
• CA 15-3 (blood test for breast cancer)      • CA 125 (blood test for ovarian cancer)
• CEA (blood test for colon cancer      • Serum protein electrophoresis (blood test for myeloma)
• Chest x-ray      • Thermography

 

 

 

 

 

 

 

 

 

 

This is a brief description of benefits and is not a contract. Please consult your coverage documents for specific covered tests and limitations. Benefit amounts, covered tests and number of payable benefits per year may vary by state. A waiting period may apply, which may vary by state. Only tests performed after the applicable waiting period qualify for reimbursement. Benefits are supplemental and are not intended to cover all medical expenses. 

 

Contact us.

Disability

Download the appropriate PDF claim form for disability insurance.

To:
Attn: Disability Claims
Trustmark Insurance Company
100 North Parkway, Suite 200 
Worcester, MA 01605
Initial/new claims fax: 508.853.2757
Existing/continuing claims or information fax: 508.854.7125

Contact us.

Dental

Download a PDF claim form for:

Contact us.

Hospital confinement

Download a PDF claim form for:

Contact us.