Policyholders

We’re dedicated to fulfilling our promise to always be here when you need us most. That's why we compiled several resources to help you easily find what you need. Get answers to frequently asked questions and download a variety of forms for your insurance policy.

Frequently Used Forms

Affidavit to Authorize to Pay Policy Benefits

Use this affidavit to authorize American Republic to make payments of benefits under your insurance policy.

Download Form

Authorization for the Use and Disclosure of Information

Use this form to grant covered entity permission to release private information to designated individuals.

Download Form

Automatic Bank Withdrawal Form

Use this form to authorize American Republic to withdraw premium payments through automatic bank drafts.

Download Form

    Life and Health Forms

    • Claim Forms

      Please fax claim forms to (515) 247-2435 or send them via mail to: 
      American Republic Insurance Company
      P.O. Box 21670
      Eagan, MN 55121-0670

      Long-term Care Claim Form
      Use this form to submit a claim regarding Long-term Care policies.

      American Republic Insurance Company CareAssist Claim Form
      Use this form to submit a claim regarding American Republic Insurance Company CareAssist polices.

      American Republic Corp Insurance Company CareAssist Claim Form
      Use this form to submit a claim regarding American Republic Corp Insurance Company CareAssist polices.

      UltraComp Critical IllnessPlus and UltraComp Cancer CarePlus Claims
      Use these claim forms when filing a critical illness/cancer claim with UltraComp policies.

    • Life Forms

      Please fax forms to (515) 247-2435 or send them via mail to: 
      American Republic Insurance Company
      Customer Care Center
      P.O. Box 1
      Des Moines, IA 50306-0001

      Request for Service
      Use this form to make changes to the beneficiary designation on your life insurance policy.

      Absolute Assignment
      Use this form to change the ownership on a life insurance policy.

      Privacy Authorization Form
      Use this document to grant covered entity permission to release information to designated individuals.

      Cash Surrender Value Request
      Cancel your life insurance policy with cash value and receive the cash surrender value.

      Partial Cash Surrender Value Request
      Take a partial withdrawal from the cash value of your LifeSavings policy but maintain coverage with a decreased death benefit.

      One-time Cash Withdrawal Form
      If dividends are earned, you may use this form to request a one-time cash withdrawal of dividends.

      Proof of Death
      This form is required when filing a death claim for a life insurance policy. It is used in conjunction with the W-9 form.

      W-9 Form
      This form is required when filing a death claim for a life insurance policy. It is used in conjunction with the Proof of Death form.

    • General Forms

      Please fax forms to (515) 247-2435 or send them via mail to: 
      American Republic Insurance Company
      Customer Care Center
      P.O. Box 1
      Des Moines, IA 50306-0001

      Nebraska External Review Request Form
      This form is only applicable for Nebraska insureds.

      Maryland Mandated Benefit Notice
      If you are a Maryland policyholder with major medical coverage, please read this notice about benefits for treatment of mental illnesses, emotional disorders, and drug and alcohol abuse that have been enacted by the state of Maryland.

      Maryland Notice of Access to Information about Proposed Rate Increases
      If you are a Maryland policyholder, you may access information about proposed rate increases and submit comments regarding proposed rate increases. 

      Oregon Policyholder Estimate of Costs
      If you are an Oregon policyholder with major medical coverage, please read this notice for detailed instructions to obtain an estimate of costs.

    Pharmacy Programs

    • Overview
      Our pharmacy programs provide our policyholders access to a variety of prescription drug discount resources. To determine if you have drug coverage through your plan, please check your schedule of benefits in your insurance contract.

      You benefit through our partnerships with pharmacy drug programs, which contract with thousands of independent and chain pharmacies throughout the United States. Out-of-pocket costs are lower than using a non-contracting pharmacy, and claims are filed electronically by the pharmacy.
    • Express Scripts, Inc.
      Managing your prescription plan shouldn't be complicated. Your prescription drug benefits include:
      • Coverage and copayments
      • Easy access to participating pharmacies
      • Prescription comparison shopping between name brands and generic alternatives
      • Access to your prescription drug history
      • Tips to lower your prescription drug costs
      • Home delivery
      • Extensive formulary
      Express Scripts is available to all individual health insurance policyholders with prescription drug coverage. Check your schedule of benefits in your insurance contract to determine if you have drug coverage and to learn which drugs are covered and not covered through your plan.

      Register on the Express Scripts, Inc. website to gain access to pharmacy tools or to get answers to questions. If you need further assistance, contact the Express Scripts, Inc. Patient Care Advocates for more details at (800) 451-6245 or call American Republic's Customer Care Center at (800) 247-2190.
       
    • MedImpact, Inc.
      The MedImpact Discount Prescription Drug program is designed for people who do not have Medicare Part D coverage. If you have Medicare Part D, you cannot participate in the program.

      MedImpact's Pharmacy Locator tool makes it easy to locate and learn about participating pharmacies. MedImpact also provides a handy online tool that calculates your estimated drug costs with your MedImpact discount.

      If you have questions about your Discount Drug Card program, please contact American Republic at the number located on your Medicare Supplement ID card.

USA Senior Care Network

USA Senior Care Network is a voluntary program designed to help save Medicare Supplement members like you money when they obtain inpatient services at a USA Senior Care Network hospital.

Learn More about the Program

Find Participating Hospitals

    Frequently Asked Questions

    • Q: How can I view my policy information?
      A: Policy details can be found inside your Policy Packet. If you no longer have a hard copy of your Policy Packet, you may download a copy within our customer portal. Click on the “Member Login” link at the top of this page to register your account. Once you’re logged in, download a PDF by clicking on the “View Policy Documents” button on the “Policies and Benefits” page.
    • Q: Where can I find my ID card?
      A: We will mail you a copy of your ID card when you register for a policy. Otherwise, you may obtain an ID card within our customer portal. Click on the “Member Login” link at the top of this page to register your account. After you’ve logged in, you can click the “Request ID Card” button on the “Policies and Benefits” page to receive a new ID card in the mail. Please note that life insurance policies do not have ID cards.
    • Q: How do I update my personal information?
      A: You may update your address, phone number, and email address within our customer portal. Click on the “Member Login” link at the top of this page to register your account. After you’ve logged in, click on “My Account” at the top of the page. If you need to change your name, please contact our Customer Care Center at (800) 247-2190.
    • Q: Can I pay my premium online?
      A: Yes. You have 31 days to pay your premium. To make a payment online, register for our customer portal by clicking on the “Member Login” link at the top of this page. You can make a one-time credit card payment or set up monthly automatic withdrawals from your bank account. You’ll need to submit the Bank Draft Authorization form located at the top of the “Forms” page to set up withdrawals.
    • Q: Can I change my method of premium payment?
      A: Yes. You may pay your premium monthly through automatic bank draft, or you may pay monthly, quarterly, semiannually, or annually by direct mail. Some methods are not available on all plans. To receive a premium quote, please contact Customer Care at (800) 247-2190, and a representative will assist you.
    • Q: How do I change the date premiums are withdrawn from my account through automatic bank drafts?
      A: You may contact Customer Care at (800) 247-2190, and we will make the necessary changes.
    • Q: I've changed banks. How do I change my automatic bank draft payments?
      A: You can update your information one of three ways:
      1. Register for our customer portal by clicking on the “Member Login” link at the top of this page and submit the Bank Draft Authorization form located at the top of the “Forms” page.
      2. Download and complete a new automatic Bank Draft Authorization form and return it to us with a voided check showing your new account number.
      3. Contact Customer Care at (800) 247-2190 to make the change.
      If you wish to discontinue withdrawals entirely, please call our Customer Care Center.
    • Q: How do I change the owner of my policy?
      A: If you wish to change the ownership of your policy to another individual, a signed request from the current policy owner is needed, or you may call our office to make the change.
    • Q: How do I remove an insured member from my policy?
      A: This request may be made by phone by calling our Customer Care Center at (800) 247-2190.
    • Q: Do you require a death certificate when an insured member dies?
      A: If we are notified within one year of the date of death, no death certificate is required. You simply need to call Customer Care at (800) 247-2190 and provide the insured’s exact date of death. If the date you notify us is more than one year from the date of death, then a death certificate is required.
    • Q: Can I borrow against my life insurance policy?
      A: You may be able to, depending on your plan type. Please contact Customer Care at (800) 247-2190 to discuss your specific plan.
    • Q: Does my policy earn dividends?
      A: Only certain life insurance policies issued by American Republic Insurance Company pay dividends and are currently receiving or being credited with dividends. If your policy does earn a dividend, you have several options on what happens to your dividend. You may:
      • Choose to receive your dividend in cash by requesting a one-time withdrawal or partial withdrawal
      • Use it to reduce your premium
      • Purchase additional paid-up insurance
      • Leave your dividend as is to accumulate interest
      You may change your dividend option at any time or withdraw dividends that have been accumulating interest whenever you wish.
    • Q: What if I'm currently receiving a senior discount on my prescriptions?
      A: The pharmacy has the option to apply a senior discount in addition to the Express Scripts, Inc. negotiated price. We encourage you to ask the pharmacist whether you can also benefit from a senior discount or other specials when purchasing a discount on the Express Scripts, Inc. price and the everyday price when the senior discount is lower. You may then choose not to use your prescription card to purchase that prescription, or you may simply choose to patronize a pharmacy that will honor both discounts.
    • Q: I've lost my prescription card. How can I get another one?
      A: Please call (800) 247-2190 from 7:30 a.m. to 5 p.m., Central time, Monday through Friday, and a Customer Care representative will be happy to order a new prescription card for you. Please allow 4-6 weeks for delivery.