Compass Accident Insurance Claims

There are different types of Accident Insurance coverage available. Please verify what coverage is available under your group policy, if any, before selecting from the claim forms below.

Compass Accident Insurance Claims

Please distribute the claim form to the insured. The Consumer Privacy Notice is attached.

Note: If the employer has submitted enrollment data electronically, the Employer form below does not need to be completed.

Form Name Form Number

Compass Accident Insurance Claim – Employee (with Consumer Privacy Notice 47316c attached) for group policies issued in all states except New York

167312 (rev 9/01/2014)

Compass Accident Claim - Employer (with Consumer Privacy Notice 47316c attached) for group policies issued in all states except New York

165759 (rev 9/01/2014)

Wellness Benefit Rider Claims

Please distribute the claim form to the insured.  The Consumer Privacy Notice is attached.

Form Name Form Number

Wellness Benefit Rider Claim Employee (with Consumer Privacy Notice 47316c attached) for group policies issued in all states except New York

165760 (rev 9/01/14)

Voya™ Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya™ family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.