Employers Producers Providers Forms COVID-19 FAQs Search

LifeMapCo

Individual Dental Plan
Dental & Vision
Explore Group Plans
Life and AD&D
Small Groups (2-25 employees)
Short Term Disability
Long Term Disability
Dental
Vision
Accident
Critical Illness
Employee Assistance Program
Employer Admin Center
Beneficiary Assistance Program
Travel Assistance Program
Members
All Members
Find a Provider
Submit a Claim
Individual Plan Members
Payment & Billing
Ask a Question
Group Plan Members
Employee Assistance Program
Global Travel Assistance Program
Moving Off an Employer's Plan
Home / Find a Form

Find a Form

I am a(n)
I'm looking for
State
Language
Narrow Results:
No Results
TitleDownloadOnline FormStates
Accident Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Accidental Death & Dismemberment Employee FlyerDownload FormAK, CA, MT, OR, UT, WA, WY
Accidental Death & Dismemberment Employee Flyer - IDDownload FormID
Accidental Dismemberment Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
ADA Dental Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Affidavit of Non-State Certified Domestic PartnershipDownload FormOR
Affidavit of Non-State Registered Domestic PartnershipDownload FormWA
Affidavit of Qualified Disabled DependentDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Affidavit of Qualifying Domestic PartnershipDownload FormAK, CA, ID, MT, UT, WY
Agent Standard Commission Schedule - AKDownload FormAK
Agent Standard Commission Schedule - CADownload FormCA
Agent Standard Commission Schedule - MT, WYDownload FormMT, WY
Agent Standard Commission Schedule - OR, ID, UTDownload FormID, OR, UT
Agent Standard Commission Schedule - WADownload FormWA
Assignment of Life Insurance Proceeds Form for Life Claim BenefitsDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Authorization for LifeMap to Release InformationDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Beneficiary Designation FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Billing FAQDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Cancer Only Critical Illness Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Cancer Only Critical Illness Employee Flyer - IDDownload FormID
Cancer Plus Critical Illness Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Cancer Plus Critical Illness Employee Flyer - IDDownload FormID
Critical Illness Cancer Care Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Dental Health Article for EmployeesDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Dental Overview for Employers 2-299Download FormAK, MT, OR, UT, WA, WY
Dental Overview for Employers 300+Download FormAK, MT, OR, UT, WA, WY
Dental Overview for ID Employers 2-299Download FormID
Dental Overview for ID Employers 300+Download FormID
Dental Voluntary Group Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Dental Waiver FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Direct Deposit Form for Claim BenefitsDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Employer Admin Center User Guide and FAQDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Employer Admin GuideDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Encuentre un dentistaDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Encuentre un oculistaDownload FormAK, ID, MT, OR, UT, WA, WY
Evidence of Insurability (EOI) Frequently Asked QuestionsDownload FormAK, ID, MT, OR, UT, WA, WY
Evidence of Insurability (EOI) with HIPAA AuthorizationDownload FormOnline Form AK, ID, MT, OR, UT, WA, WY
Extended Life Insurance Claim Form for EmployeeDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Extended Life Insurance Claim Form for SpouseDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Find a DentistDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Find a Vision Provider - GroupDownload FormAK, ID, MT, OR, UT, WA, WY
Folleto de accidente para empleadosDownload FormID, MT, OR, UT, WA, WY
Folleto de Cáncer Plus (Enfermedad grave) para empleadosDownload FormAK, ID, MT, OR, UT, WA, WY
Folleto de Cobertura dental colectiva para empleadosDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Folleto de Cobertura dental voluntaria para empleadosDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Folleto de Discapacidad de corto plazo para empleadosDownload FormAK, ID, MT, OR, UT, WA, WY
Folleto de Discapacidad de largo plazo para empleadosDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Folleto de muerte accidental y desmembramientoDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Folleto de Única cáncer (Enfermedad grave) para empleadosDownload FormAK, ID, MT, OR, UT, WA, WY
Folleto de Vida colectiva para empleadosDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Folleto de Vida voluntaria para empleadosDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Formulario de Evidencia de Asegurabilidad con Autorización HIPAADownload FormAK, CA, ID, MT, OR, UT, WA, WY
Group Dental Employee FlyerDownload FormAK, CA, MT, OR, UT, WA, WY
Group Dental Employee Flyer - IDDownload FormID
Group Products Overview 10+Download FormAK, MT, OR, UT, WA, WY
Group Products Overview 10+ CADownload FormCA
Group Products Overview 10+ IDDownload FormID
Group Products Overview Express 2-9 CADownload FormCA
HIPAA Authorization to Disclose Protected Health InformationDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Individual Critical Illness and Emergency Treatment Benefit Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Individual Dental Enrollment Packet - IDDownload FormID
Individual Dental Enrollment Packet - ORDownload FormOR
Individual Dental Enrollment Packet - UTDownload FormUT
Individual Dental Enrollment Packet - WADownload FormWA
Individual Dental Member Brochure - IDDownload FormID
Individual Dental Member Brochure - ORDownload FormOR
Individual Dental Member Brochure - UTDownload FormUT
Individual Dental Member Brochure - WADownload FormWA
Individual Dental Rates 4/1/2023 to 6/30/2023 - IDDownload FormID
Individual Dental Rates 4/1/2023 to 6/30/2023 - ORDownload FormOR
Individual Dental Rates 4/1/2023 to 6/30/2023 - UTDownload FormUT
Individual Dental Rates 4/1/2023 to 6/30/2023 - WADownload FormWA
Individual Dental Rates 7/1/2023 to 9/30/2023 - IDDownload FormID
Individual Dental Rates 7/1/2023 to 9/30/2023 - ORDownload FormOR
Individual Dental Rates 7/1/2023 to 9/30/2023 - UTDownload FormUT
Individual Dental Rates 7/1/2023 to 9/30/2023 - WADownload FormWA
Individual Short Term Medical Pharmacy Reimbursement FormDownload FormID, OR, UT, WA
Individual Vision Rider Reimbursement FormDownload FormID, OR, UT
Initial Premium InvoiceDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Inscribirse en el Centro Dental de LifeMapDownload FormAK, CA, ID, MT, OR, UT, WA, WY
La hoja de trabajo del seguro de vidaDownload FormAK, CA, ID, MT, OR, UT, WA, WY
La hoja de trabajo del seguro por discapacidadDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Life Conversion Request for Information FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Life Employee FlyerDownload FormAK, CA, MT, OR, UT, WA, WY
Life Insurance Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Life Insurance WorksheetDownload FormAK, CA, MT, OR, UT, WA, WY
Life Insurance Worksheet - IdahoDownload FormID
LifeMap Advantages Member FlyerDownload FormAK, CA, ID, MT, OR, UT, WA, WY
LifeMap Enrollment Change FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
LifeMap Protect 10 Benefit SummaryDownload FormID, OR, UT, WA
LifeMap Protect 20 Benefit SummaryDownload FormID, OR, UT, WA
LifeMap Protect 30 Benefit SummaryDownload FormID, OR, UT, WA
LifeMap Protect Plans FlyerDownload FormID, OR, UT, WA
Long Term Disability Claim FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Long Term Disability Employee FlyerDownload FormAK, CA, MT, OR, UT, WA, WY
Long Term Disability Employee Flyer - IDDownload FormID
Notice of Privacy Practices - STM, Vision, DentalDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Privacy NoticeDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Regence Life Solutions Life 10 Benefit SummaryDownload FormID, OR, UT, WA
Regence Life Solutions Life 20 Benefit SummaryDownload FormID, OR, UT, WA
Regence Life Solutions Life 30 Benefit SummaryDownload FormID, OR, UT, WA
Risk Evaluation FormDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Short Term Disability Claim FormDownload FormAK, ID, MT, OR, UT, WA, WY
Short Term Disability Claim Form - Employee's StatementOnline Form AK, ID, MT, OR, UT, WA, WY
Short Term Disability Overview for EmployersDownload FormAK, MT, OR, UT, WA, WY
Short Term Disability Overview for ID EmployersDownload FormID
Small Group (10-25 Employees) Basic Life and AD&D Benefit SummaryDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (10-25 Employees) Dental Plan J Benefit SummaryDownload FormID, OR, UT, WA
Small Group (10-25 Employees) Dental Plan K and L Benefit SummaryDownload FormID, OR, UT, WA
Small Group (10-25 Employees) Dental Plan OptionsDownload FormID, OR, UT
Small Group (10-25 Employees) LTD Benefit SummaryDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (10-25 Employees) Master ApplicationDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Small Group (10-25 Employees) STD Benefit SummaryDownload FormAK, ID, MT, OR, UT, WY
Small Group (10-25 Employees) Voluntary Life and AD&D Benefit SummaryDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (10-25 Employees) Washington Dental Plan Options (Active PPO Plans)Download FormWA
Small Group (10-25 Employees) Washington Dental Plan Options (Passive PPO Plans)Download FormWA
Small Group (2-25 Employees) Implementation WorksheetDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Small Group (2-25 Employees) Service DirectoryDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Small Group (2-25 Employees) Vision Benefit Summary - $130 Frame AllowanceDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (2-25 Employees) Vision Benefit Summary - $150 Frame AllowanceDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (2-25 Employees) Washington Dental Plan L with TMJ Benefit SummaryDownload FormWA
Small Group (2-9 Employees) Basic Life and AD&D Benefit SummaryDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (2-9 Employees) Dental Plan A Benefit SummaryDownload FormID, OR, UT
Small Group (2-9 Employees) Dental Plan C Benefit SummaryDownload FormID, OR, UT
Small Group (2-9 Employees) Dental Plan OptionsDownload FormID, OR, UT
Small Group (2-9 Employees) LTD Benefit SummaryDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (2-9 Employees) Master ApplicationDownload FormAK, CA, ID, MT, OR, UT, WA, WY
Small Group (2-9 Employees) STD Benefit SummaryDownload FormAK, ID, MT, OR, UT, WY
Small Group (2-9 Employees) Voluntary Life and AD&D Benefit SummaryDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group (2-9 Employees) Washington Dental Plan J Benefit SummaryDownload FormWA
Small Group (2-9 Employees) Washington Dental Plan K Benefit SummaryDownload FormWA
Small Group (2-9 Employees) Washington Dental Plan L Benefit SummaryDownload FormWA
Small Group (2-9 Employees) Washington Dental Plan OptionsDownload FormWA
Small Group (5-9 Employees) Washington Dental Plan L with Ortho Benefit SummaryDownload FormWA
Small Group Basic Life and AD&D Plan OptionsDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group LTD Plan OptionsDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group STD Plan OptionsDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group Vision Plan OptionsDownload FormAK, ID, MT, OR, UT, WA, WY
Small Group Voluntary Life and AD&D Plan OptionsDownload FormAK, ID, MT, OR, UT, WA, WY
STM Authorization For Use and Disclosure of Protected Health InformationDownload FormID, OR, UT, WA
Vision Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Vision Employee Flyer - IDDownload FormID
Vision Employee Waiver FormDownload FormAK, ID, MT, OR, UT, WA, WY
Vision Out of Network Reimbursement FormDownload FormAK, ID, MT, OR, UT, WA, WY
Voluntary Accident Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Voluntary Accident Employee Flyer - IDDownload FormID
Voluntary Accidental Death & Dismemberment Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Voluntary Accidental Death & Dismemberment Employee Flyer - IDDownload FormID
Voluntary Group Dental Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Voluntary Group Dental Employee Flyer - IDDownload FormID
Voluntary Life Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Voluntary Life Employee Flyer IDDownload FormID
Voluntary Long Term Disability Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Voluntary Long Term Disability Employee Flyer - IDDownload FormID
Voluntary Short Term Disability Employee FlyerDownload FormAK, MT, OR, UT, WA, WY
Voluntary Short Term Disability Employee Flyer - IDDownload FormID
Wellness Benefit StatementDownload FormAK, CA, ID, MT, OR, UT, WA, WY

Member Dashboard

Employer Dashboard

Producer Dashboard