Download Claim Forms

When accessing or downloading online forms, you agree to release, indemnify and hold harmless Ameritas Life Insurance Corp. and/or its subsidiaries for any damage or liability encountered from using these forms. Please remember to keep only the most current Ameritas or Ameritas Life Insurance Corp. of New York forms on file.

Claim Forms

English Dental Claim Form
Spanish Dental Claim Form
Ameritas Vision Claim Form – for Vision Perfect plans, Dental plans with LASIK, Fusion plans and Dental plans with Exam Only benefit
Spanish Ameritas Vision Claim Form 
EyeMed Vision Out-of-Network Claim Form
VSP Vision Out-of-Network Claim Form
Total Vision Accidental Loss of Sight Claim Form
SoundCare Claim Form – for hearing care plans.
Individual Dental Claim Form – for individual plans
Individual Vision Claim Form – for individual plans

Claim Forms (NY)

English Dental Claim Form(NY)
Spanish Dental Claim Form (NY)
Ameritas of New York Vision Claim Form (NY) – for Vision Perfect plans, Dental plans with LASIK, Fusion plans and Dental plans with Exam Only benefit
Spanish Ameritas of New York Vision Claim Form (NY)
EyeMed Vision Out-of-Network Claim Form (NY)
VSP Vision Out-of-Network Claim Form (NY)
Total Vision Accidental Loss of Sight Claim Form (NY)
SoundCare Claim Form (NY) – for hearing care plans