Redirect Slug

Are you a Benefits Broker?

Redirect Link

Workplace Benefits Claims

Dental Claim Form

This is the standard form created by the American Dental Association. It must be completed by your Dental provider.

Critical Illness Claim Form (GG015197)

This is the standard form to be used when submitting a claim on a Guardian Critical Illness insurance policy (claims for critical illness, hospital admission, and/or wellness benefits for the policy).

Life Claim Form (GG-42)

This form consists of two sections, the claimant section, and the employer section. Both sections must be completed and signed appropriately.

Short Term Disability Claim (GG-011096)

This form consists of three sections, the claimant section, the employer section, and the physician section. All sections must be completed and signed appropriately.

LTD Claim Packet

New York (DBL) Disability Benefits Law-Claim Form (DB450)

This New York form consists of three sections, the claimant section, the employer Section and the physician section. All three sections should be completed in full and submitted for consideration of NY State Disability (DBL) benefits. An incomplete submission may cause undue delay in the ability to make a claim determination.

Statement of Rights-Disability Benefits Law (DB271S)

This form provides a simplified presentation of your rights as required by Section 229 of the Disability Benefits Law.

New Jersey (TDB) Temporary Disability Benefits-Claim Forms (NJTDBDS1)

This form consists of three sections, the claimant section, the employer section, and the physician section. All three sections should be completed in full and submitted for consideration of NJ State Disability (TDB) benefits. An incomplete submission may cause undue delay in the ability to make a claim determination.

CAN'T FIND WHAT YOU'RE LOOKING FOR?

If you can't find the form you're looking for, login to Guardian Anytime for additional claim forms.

Workplace Benefits Administration
For Guardian Workplace Benefits Products

Guide for Managing Self-Administered Plans

A reference guide overviewing employers' key administration responsibilities. Or, view our quick tutorial.

Request for Group Insurance Supplies (GG-13)

This is the standard form to be used when submitting a claim on a Guardian Critical Illness insurance policy (claims for critical illness, hospital admission, and/or wellness benefits for the policy).

Request to assign or change a beneficiary (GG-17)

Election of Continued Coverage (COBRA)GG-975

Used for terminated employees to elect federal continuation under the plan.

Coverage Management Prescription Drug Program

The latest program rules and drug listings with instructions for prior authorization.

CAN'T FIND WHAT YOU'RE LOOKING FOR?

If you cannot find the form you're looking for, login to Guardian Anytime for additional claim forms.

Health Care Providers

Specialty Referral Request (Form 177-012)

Use to request a referral for special dentistry services.

Member Treatment Data Form (Form 177-014)

Use to specify type of treatment administered to patient.

Life Insurance

Guard-O-Matic Form (R-223)

By completing this form you can set up a monthly draft for premium payments or change your banking information. When setting up a draft or changing bank information, please include a voided check with your form.

Title Form (016256)

By completing this form the name, owner, or beneficiary designation will be changed as indicated. Once the company receives this form, all other documents pertaining to name, ownership and beneficiaries will be null and void. That means if you want any of the beneficiaries previously named to continue as your  beneficiaries, you must include their names on this form. 

Trust Certification

This form should be used for all new business cases in which a trust will own the policy and in situations when an in force policy ownership change involves a trust. The form provides additional information and clarity regarding the trust and the signing authority of the trustees and in many cases will eliminate the need for you to provide a copy of the trust documents for review. However, there are certain circumstances in which Guardian will still also require the Trust documents, including, but not limited to, the following: (1) Pension Trust Cases, (2) Premium Financing Cases, (3) Cases involving Captive Insurance Companies and (4) Any application on an insured age 70 or more and the total face amount applied for is $1,000,000 or more.

Online Policy Service Request

ANNUITIES

Notice of Name Ownership Change Form

Use this form to change the owner's or annuitant's name or change the owner.

Address Change Form

Use this form to change your address on your annuity contract.

Designation of Beneficiary Form-- Non Qualified

Use this form to change your beneficiary designation.

Designation of Beneficiary Form -- Qualified

Use this form to change your beneficiary designation.

Telephone Transfer/Allocation Change Authorization Form

Use this form to establish a PIN for telephone transactions. 

Direct Deposit Authorization Form

Use this form to establish direct deposit of any withdrawals/payments from your annuity contract to a bank account. 

Application for Duplicate Copy of Contract Lost or Destroyed

Use this form to request a duplicate copy of your annuity contract.