Compass Accident Insurance Claims

You may be eligible to receive an Accident benefit and/or a Wellness benefit under your Accident Insurance certificate. Please review your certificate and riders for the eligibility requirements to receive benefits.

To submit a Compass Accident Insurance Claim:

Please print the Accident Insurance Claim form below. The Consumer Privacy Notice is attached.

Note: If your employer has submitted enrollment data electronically, the Employer form below does not need to be completed.

Submit the completed and signed form(s) to the address shown at the top of the form, along with any other required information such as itemized bill(s) or Explanation of Benefits (EOB).

Form NameForm Number

Compass Accident Insurance Claim - Employee (with Consumer Privacy Notice 47316c attached) for group policies issued in all states except New York

167312 (2/7/14)

Compass Accident Claim  - Employer (with Consumer Privacy Notice 47316c attached) for group policies issued in all states except New York

165759 (11/11/13)

To submit a Wellness Benefit Rider Claim:

Please print the Wellness Benefit Rider Claim form below. The Consumer Privacy Notice is attached.

Submit the completed and signed form to the address shown at the top of the form.

Form NameForm Number

Wellness Benefit Rider Claim Employee (with Consumer Privacy Notice 47316c attached) for group policies issued in all states except New York

165760 (07/01/2014)