UCT Dental, Vision and Hearing Expense Insurance

• Dental, Vision and Hearing Expense Insurance – U.S. (Form No. C-DVH REV. 6/13)

Universal Claim Form

Used for products Accidental Death and Hospital Indemnity Plan (ADHIP), Hospital Indemnity Plan (HIP), Emergicare Plus, Spousal Indemnity Plan (SIP), and Membership and Accident Coverage Protection (MAC)

• Universal Claim Application (Form No. C-1050 REV. 5/19)

AME Claim Form

Used for Accident Medical Expense Insurance (AME)

• Accident Medical Expense Insurance Claim Application (Form No. C-AME REV. 8/17)

DIP Claim Form

Used for Disability Income Plan (DIP)

• Disability Income Plan Claim Application (Form No. C-1001 REV. 4/9)