Submitted by tmaillard on Mon, 09/20/2021 - 20:32
Claim Forms

Reporting a claim is simple. You can call Customer Service at 1-800-433-1672 or obtain forms through the links below.

Please click and download the appropriate claim form for your needs. Completed forms can be mailed to:
ACS Insurance Program
P.O. Box 153054
Irving, TX 75015-3054

Disability Income/Office Overhead Expense Claim Form

Hospital Indemnity Claim Form

Bank Draft Authorization

Request other forms or information
Forms
Send a copy of my Certificate of Insurance for the following coverage(s):
NYL-5031914