Insurance Forms & Resources

As an Olde Fayetteville Insurance client, please feel free to take advantage of these resources to find your insurance forms. We added some of the most requested forms so the information you need is right at your fingertips. Please know that you can contact our office if you have any questions about the insurance forms below.

 2023 CCS Benefit Book

Aflac - Critical Illness & Accident

• Aflac Accident  Claim Form: Download Form

• Aflac Accident Wellness Claim Form: Download Form

• Aflac Critical Illness Claim form: Download Form

• Aflac Critcal Illness Wellness Claim: Download Form

Allstate - Claim Forms

• Allstate Accident Physician's Treatment Claim Form: Download Form

• Allstate Group Accident Claim Form (CCS) Download Form

• Group Cancer Claim Form: Download Form

• Wellness Claim Form: Download Form

• Critical Illness Claim Form: Download Form

• Policy Service form (ex. address, name, beneficiary changes):  Download form

• Allstate SHOP Information: Download Brochure        

• SHOP Claim Form: Download Form

• Allstate GIM2 (Group Indemnity Medical): Download Form

• Allstate Claims Service Number: 1-800-348-4489

• Allstate Policyholder Service Number: 1-800-521-3535

• NEW 2023- Allstate Cancer Plan for Cumberland County School Employees

Boston Mutual Life Insurance

• Life Insurance:  Boston Mutual Claim Form (3) (1)

Manhattan Life (formerly Humana Policies) - Forms & Policies

• Manhattan Life Cancer Forms (Policies issued prior to 1/1/14)

  • Manhattan Life Cancer Plus Claim Form

  • Manhattan Life Cancer Claim Form

• Manhattan Life (formerly Humana -Cumberland County School Employees ONLY)

  • Service request form

  • Beneficiary change form

Texas Life Whole Life Insurance

For Customer Service: 1-800-283-9233 press #2

 Protective Life Insurance Company (universal life and term)

Policy holder Service Form: Download Form

Policy Holder Beneficiary Change Form: Download Form

For Forms and Customer Service: Local 1-910-483-6210

TRANSAMERICA

Cancer Select Plus and TransElite (Universal Life Insurance)

Policy Holder Service Form: Claims for TRANSAMERICA can be filed by calling TRANSAMERICA direct at 1-800-251-7254 or by logging into their site at www.tebcs.com.  You will need your policy number in order to log in.

TRANSAMERICA Wellness Instructions

For questions you can call Olde Fayetteville Insurance at 910-483-6210.

The HealthPlan (Dental, Vision, Short Term Disability and Flexible Spending Accounts for CCS Employees)

FSA Customer Service- 1-866-347-3640

FSA Claim Form - Download here

Dental, Vision and Short Term Disability Customer Service- 1-910-484-1819

Click here for Contracted Dental Practices

Dental Claim Form

Vision Claim Form

For Dental and Vision Reimbursements,  members can mail the itemized statement and proof of payment into the following address.

The Health Plan

1110 Main Street

Wheeling WV, 26003

 Trustmark- Hospital Stay Pay

Plan details click here

(CCS and PWC employees) Customer Service- 1-800-918-8877 Option 6

 Trustmark - New for 2023 - Universal Life Insurance with Long Term Care

 Cumberland County Schools Benefit Cancellation form: Click Here