Health Forms / Disclosures

Find the forms you need for dental, vision, hearing and LASIK insurance benefits with Ameritas. For the best experience, please download the form before using the fillable fields. If you are submitting a claim, check with your provider to make sure they are not submitting the claim on your behalf.

Don’t see what you’re looking for? Check out the Resource Center.

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Are you a dental provider?

Submit dental claims electronically to expedite processing time. Every claim can be submitted electronically, including orthodontic, periodontal, pretreatment estimates and claims with attachments.

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.