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Puerto Rico
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Forms

For your convenience, all our claims and services forms are available online.

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Claim Forms

Accident

PDF

Cancer/
Illness

PDF

Preventive
testing

PDF

Initial
disability

PDF

Disability continuity

PDF

Decease

PDF

Service Forms

Request for amendment or service

PDF

Payroll deduction authorization

PDF

Electronic transfer authorization

PDF

Application for reinstatement Cancer and Supplementaries

PDF

Supplementary plan conversion

PDF

Privacy Policy

PDF

Direct Deposit of Claim Payment

PDF

List of claim requirements

Requirements for Cancer Única

PDF

Requirements for
Cancer Elite

PDF

Requirements for Organ Transplant

PDF

How can I make a current claim?

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En TOLIC tenemos la obligación de enviar la Informativa 480.7F, a todos los clientes comerciales y cuenta propistas, para los pagos de prima de Aportaciones a planes de salud o accidentes durante el año Contributivo 2023.

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