Group Benefits forms are available below, as well as on

The fastest, most secure way to submit forms and supporting documents is our Document Submission Tool. Login to, then select My Resources > Document Submission. Uploaded forms are instantly sent to our teams.

Submitting a claim?

Health and Dental Claims

Submit claims anytime and get faster claim payments with Equitable EZClaim®

We’ve made submitting health and dental claims fast, easy and secure with Equitable EZClaim. Most eligible claims are paid within three business days; some in as little as 24 hours!

Learn how to use EZClaim to submit claims on your computer or mobile device.

If you need help submitting a claim, please contact our claims teams.

Disability Claims

To submit a disability claim, print, complete and submit the appropriate form to Equitable Life. If your plan requires your group plan administrator to provide an authorizing signature, be sure to obtain the signature before submitting your claim.

If the form you need doesn't appear below, please log in to, click on "My Resources" and select "Forms" from the drop-down menu.

Submit your disability forms instantly using our Document Submission Tool. Login to, then select My Resources > Document Submission.

No. Name
441 Application for Coverage for Dependent Child over 21 Administration Forms
564 Application For Long Term Disability Benefits - Employee Disability Claims
188QA Attending Physician's Statement General Disability Claims
573 Coverage2go Application Administration Forms
Group Admin
Marketing Materials
210 Group Life & Dependent Life Claim - Statement of Employer Disability Claims
1781 Group Life & Disability Claims Guide Plan Administrator Disability Claims
2015 Group Life & Disability Claims Guide Plan Member Disability Claims
684 Group Life Claim - Claimant’s Statement Disability Claims
427 Ongoing Long Term Disability Update Disability Claims
509 Optional Life Insurance Application and Statement of Health Administration Forms
456 Plan Member Group Life and AD&D Insurance Beneficiary Designation Administration Forms
421 Short Term Disability Claim Form Disability Claims
421B Short term disability employer COVID-19 claim form Disability Claims
421A Short term disability plan member COVID-19 claim form Disability Claims
452 Statement of Health for Group Insurance Administration Forms