Whether you need to change your beneficiaries, check on the status of a claim or any other concerns, we are here to assist you.

File an Insurance Claim - Standard Premiums

When you need us most, the last thing you want is a difficult, drawn out claim process. That's why Combined Insurance is different ... we strive to make it easy to file insurance claims.

To file Combined Insurance claims for standard premiums*, print the Claim Form Instructions, then simply click on your state of residence from the following list and print out the appropriate form. Complete the form; specific sections must be completed by your employer and doctor, and return the form to us at:

Combined Insurance
Claim Department
P.O. Box 6700
Scranton, PA 18505-0700

Claim Form Instructions

U.S. Form (All States with the exception of New York)
English / Spanish

New York Form
English / Spanish

Claim Forms

*If your premium is paid through payroll deductions, please click here.

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My Self Service Account

The Self Service Portal provides customers instant access to view policies, payment history, and claim information. Click on the link below to manage your account online.

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