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.

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
185QA Attending Physician's Statement Cancer Disability Claims
187QA Attending Physician's Statement Cardiac Disability Claims
188QA Attending Physician's Statement General Disability Claims
184QA Attending Physician's Statement Musculoskeletal Disability Claims
186QA Attending Physician's Statement Psychiatric Disability Claims
190 Authorization for Direct Deposit Administration Forms
210B Claim For Accidental Dismemberment Benefit Disability Claims
573 Coverage2go Application Administration Forms
Group Admin
Marketing Materials
684B Foreign Death Claim Disability Claims
209 Group Dependent Life Claim - Statement of Employer Disability Claims
210 Group Life & Dependent Life Claim - Statement of Employer Disability Claims
1781 Group Life & Disability Claims Guide Disability Claims
684 Group Life Claim - Claimant’s Statement Disability Claims
529 Group Life Insurance Waiver Of Premium Application - Employee Form - Ongoing Eligibility Review Disability Claims
523B Group Life Insurance Waiver of Premium Application - Employer Form Disability Claims
238 Long Term Disability Employer 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
683 Proof of Death - Physician's Statement Disability Claims
567 QuickAssess Absence And Accommodation Review Service - Employer Referral Form Disability Claims
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
425 Short Term To Long Term Disability Application - Employee Disability Claims
426 Short Term To Long Term Disability Application - Employer Disability Claims
452 Statement of Health for Group Insurance Administration Forms
420 Status On Return Of Absent Employee Disability Claims
422 Supplementary Report on Claim for Disability Benefits Disability Claims