The list below contains forms available for download for current AMA Insurance certificate holders. If you have any questions about these forms, or would like AMA Insurance to mail you a form instead, please contact us.
Please note that some of the forms below allow you to type information directly into the PDF, however, for privacy purposes, you may not save a filled out form.
Change a Beneficiary/Owner/Assignee
Transfer of Ownership (Absolute Assignment) Forms
File a Claim
Dental Insurance
Hospital Income (Hospital Indemnity) Insurance Plan
Hospital Income (Hospital Indemnity) Insurance Form
In order to file a claim, complete, date, sign and return this form with one of the following: 1) A UB-04 form issued by the hospital. 2) An itemized hospital bill, along with a diagnosis provided by your attending physician. A balance due statement is not acceptable. 3) A statement from the hospital indicated the admission date, discharge date, number of days, type of room and diagnosis.
In order to file a claim, complete, date, sign and return this form with one of the following: 1) A UB-04 form issued by the hospital. 2) An itemized hospital bill, along with a diagnosis provided by your attending physician. A balance due statement is not acceptable. 3) A statement from the hospital indicated the admission date, discharge date, number of days, type of room and diagnosis.
Catastrophic Major Medical/Excess Major Medical Insurance
For All Other Claims
Please contact Customer Care at 800.458.5736 (8 am – 5 pm CT, Monday – Friday).
Add Dependents
Hospital Income (Hospital Indemnity) Insurance Plan
Change Billing Information
Automatic Payments
Electronic Fund Transfer (EFT) Enrollment Form
Enroll in EFT to setup automatic monthly payments from your bank account.
Enroll in EFT to setup automatic monthly payments from your bank account.
Add Secondary Address
Add Secondary Addressee Form
Add another address/individual to your account. They will receive a copy of billing and lapse notices to help prevent unintentional lapse of insurance coverage.
Add another address/individual to your account. They will receive a copy of billing and lapse notices to help prevent unintentional lapse of insurance coverage.
Helpful Resources
Catastrophic Major Medical Insurance Hospital Directory
View the directory of hospitals in the CMM plan. Admittance to a network hospital is recommended but not required by this plan.
SMRU #1766472