Use this tool to help find the appropriate form. Simply select the audience that best fits you and the state you or your company resides in. If you are an employee covered under a group plan with LifeMap, you are a group plan member and don’t need to select a state. Feel free to reach out to us with any questions you have along the way.

Title Download State
Individual Critical Illness Plus Application - ID PDF icon Download PDF (857.59 KB) ID
Individual Critical Illness Plus Application - OR PDF icon Download PDF (174.54 KB) OR
Individual Critical Illness Plus Application - WA PDF icon Download PDF (1.03 MB) WA
Individual Critical Illness Plus Beneficiary Form PDF icon Download PDF (83.93 KB) ID, OR, UT, WA
Individual Critical Illness Plus Enrollment Packet- UT PDF icon Download PDF (723.12 KB) UT
Individual Critical Illness Plus Flyer PDF icon Download PDF (112.64 KB) OR, UT, WA
Individual Critical Illness Plus Flyer - ID PDF icon Download PDF (113.27 KB) ID
Individual Dental Application - ID PDF icon Download PDF (136.36 KB) ID
Individual Dental Application - OR PDF icon Download PDF (1.13 MB) OR
Individual Dental Application - UT PDF icon Download PDF (131.54 KB) UT
Individual Dental Application - WA PDF icon Download PDF (1.22 MB) WA
Individual Dental Member Brochure - ID PDF icon Download PDF (193.48 KB) ID
Individual Dental Member Brochure - OR PDF icon Download PDF (2.2 MB) OR
Individual Dental Member Brochure - UT PDF icon Download PDF (193.42 KB) UT
Individual Dental Member Brochure - WA PDF icon Download PDF (2.2 MB) WA
Individual Dental Rates 10/1/2019 to 12/31/2019 - ID PDF icon Download PDF (69.26 KB) ID
Individual Dental Rates 10/1/2019 to 12/31/2019 - OR PDF icon Download PDF (82.59 KB) OR
Individual Dental Rates 10/1/2019 to 12/31/2019 - UT PDF icon Download PDF (74.24 KB) UT
Individual Dental Rates 10/1/2019 to 12/31/2019 - WA PDF icon Download PDF (70.37 KB) WA
Individual Dental Rates 7/1/2019 to 9/30/2019 - ID PDF icon Download PDF (69.5 KB) ID
Individual Dental Rates 7/1/2019 to 9/30/2019 - OR PDF icon Download PDF (83.2 KB) OR
Individual Dental Rates 7/1/2019 to 9/30/2019 - UT PDF icon Download PDF (74.48 KB) UT
Individual Dental Rates 7/1/2019 to 9/30/2019 - WA PDF icon Download PDF (70.67 KB) WA
Individual Short Term Medical Enrollment Packet - ID eff 1/1/2019 PDF icon Download PDF (444.92 KB) ID
Individual Short Term Medical Enrollment Packet - OR eff 1/1/2019 PDF icon Download PDF (360.88 KB) OR
Individual Short Term Medical Enrollment Packet - UT eff 1/1/2019 PDF icon Download PDF (446.82 KB) UT
Individual Short Term Medical Enrollment Packet - WA eff 4/1/2019 PDF icon Download PDF (363.86 KB) WA
Individual Short Term Medical Member Flyer PDF icon Download PDF (915.92 KB) OR, UT, WA
Individual Short Term Medical Member Flyer - ID PDF icon Download PDF (208.59 KB) ID
Individual Short Term Medical Pharmacy Reimbursement Form PDF icon Download PDF (32.81 KB) ID, MT, OR, UT, WA
Individual Short Term Medical Rates 10/1/2019 to 12/31/2019 - ID PDF icon Download PDF (48.19 KB) ID
Individual Short Term Medical Rates 10/1/2019 to 12/31/2019 - OR PDF icon Download PDF (48.06 KB) OR
Individual Short Term Medical Rates 10/1/2019 to 12/31/2019 - UT PDF icon Download PDF (47.97 KB) UT
Individual Short Term Medical Rates 10/1/2019 to 12/31/2019 - WA PDF icon Download PDF (48.18 KB) WA
Individual Short Term Medical Rates 7/1/2019 to 9/30/2019 - ID PDF icon Download PDF (47.85 KB) ID
Individual Short Term Medical Rates 7/1/2019 to 9/30/2019 - OR PDF icon Download PDF (47.81 KB) OR
Individual Short Term Medical Rates 7/1/2019 to 9/30/2019 - UT PDF icon Download PDF (47.71 KB) UT
Individual Short Term Medical Rates 7/1/2019 to 9/30/2019 - WA PDF icon Download PDF (47.93 KB) WA
Individual Vision Rider Reimbursement Form PDF icon Download PDF (33.05 KB) ID, OR, UT
Life Insurance Claim Form PDF icon Download PDF (284.21 KB) AK, CA, ID, MT, OR, UT, WA, WY
LifeMap Advantages Beltone ID Card PDF icon Download PDF (41.49 KB) AK, CA, ID, MT, OR, UT, WA, WY
LifeMap Advantages Member Flyer PDF icon Download PDF (823.57 KB) AK, CA, ID, MT, OR, UT, WA, WY
Notice of Privacy Practices - STM, Vision, Dental PDF icon Download PDF (126.25 KB) AK, CA, ID, MT, OR, UT, WA, WY
Privacy Notice PDF icon Download PDF (24.05 KB) AK, CA, ID, MT, OR, UT, WA, WY
STM Authorization For Use and Disclosure of Protected Health Information PDF icon Download PDF (129.8 KB) ID, MT, OR, UT, WA