Policyholders

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.

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 request changes to your life insurance policy.

Beneficiary Designation
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.

Policy Loan Agreement
Use this form to request a loan against your policy.

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.

American Republic Insurance Company Proof of Death Form
This form is required when filing a death claim for a life insurance policy with American Republic Insurance Company.

American Republic Corp Insurance Company Proof of Death Form
This form is required when filing a death claim for a life insurance policy with American Republic Corp Insurance Company.

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.

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.

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.
 

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.

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.

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.

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.

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.

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.

A: You may contact Customer Care at (800) 247-2190, and we will make the necessary changes.

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.

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.

A: This request may be made by phone by calling our Customer Care Center at (800) 247-2190.

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.

A: You may be able to, depending on your plan type. Please contact Customer Care at (800) 247-2190 to discuss your specific plan.

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.

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.

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.