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Important Information and Corporate Links

It's simple to apply: Download, print, and complete the appropriate application. Then fax it to our offices at 317.262.2140.

File formats include Adobe Acrobat (PDF), HTML (for your web browser), and Microsoft Word (DOC). To view PDF files you will need Adobe Acrobat Reader. You can download the software for free: 



Skip the Forms, Apply Online Now

Claim Forms
    Claimant's Statement (Standard Form)PDF (44.5 KB)
    Non US Claim FormPDF (39.2 KB)
    Dental Claim FormPDF (41.18 KB)
    Accident QuestionnairePDF (29.93 KB)
    Spanish Claimant's Statement (Standard Form)PDF (45.39 KB)
    Spanish Non US Claim FormPDF (39.08 KB)
    Spanish Dental Claim FormPDF (41.36 KB)
    Spanish Accident QuestionnairePDF (31.67 KB)
    Trip Cancellation SeriesHTML
    CorpsCareHTML
 
Provider Direct Pay Agreement
    Direct Payment AgreenmentPDF (25.16 KB)
 
Atlas Travel Insurance
    Brochure and ApplicationPDF (170.55 KB)
    Brochure onlyHTML
    Rates and InstructionsHTML
    Spanish Brochure and ApplicationPDF (204.48 KB)
    Spanish Brochure onlyHTML
 
Atlas Group
    Brochure and ApplicationPDF (155.71 KB)
    Spanish Brochure and ApplicationPDF (164.8 KB)
 
Atlas Professional (Multiple Trip Coverage)
    Brochure and ApplicationPDF (480.09 KB)
    Spanish Brochure and ApplicationPDF (494.25 KB)
 
Atlas Corporate Travel
    Brochure and ApplicationPDF (168.98 KB)
    Spanish Brochure and ApplicationPDF (213.7 KB)
 
GroupSecureSM
    BrochurePDF (521.23 KB)
    Enrollment FormPDF (42.08 KB)
    Request for ProposalPDF (39.92 KB)
    Spanish BrochurePDF (322.66 KB)
    Spanish Enrollment FormPDF (45.61 KB)
    Spanish Request for ProposalPDF (36.89 KB)
 
Privacy Policy
    Privacy PolicyPDF (32.33 KB)
 
IC+ Term Life
    BrochurePDF (46.95 KB)
    ApplicationPDF (38.37 KB)
 
StudentSecureSM
    Brochure and ApplicationPDF (669.78 KB)
    Spanish Brochure and ApplicationPDF (591.36 KB)
 
CitizenSecureSM, Major Medical Insurance
    BrochurePDF (923.42 KB)
    Spanish BrochurePDF (1.87 MB)
    Application and RatesPDF (103.75 KB)
    Spanish Application and RatesPDF (76.98 KB)
 
CitizenSecureSM Economy
    BrochurePDF (923.42 KB)
    Spanish BrochurePDF (1.87 MB)
    Application and RatesPDF (96.32 KB)
    Spanish Application and RatesPDF (73.85 KB)
 
HCC Life STM
    Please Select a State to access the
    Brochure, Application, Rate and
    Claimant's Statement documents.

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