Colonial Hospital Income Policy Claim Form & Filing Instructions

**If you need to file a claim on your Colonial Hospital Income policy, you can call the Member Solutions team toll-free at 1-800-233-2204 (7 days a week, 24 hours a day). You may also:

- Access the forms online from your account.

- Or fill out this claim form and submit the form to the appropriate address below:**

Colonial Life & Accident Insurance Company

ATTN: Claims Department

P.O. Box 222294

Charlotte, NC 28222-2294

Faxed claims should be sent to [phone].

When filing a claim, please note that you will need the following information:

- Your policy number

- The name of the insured person

- The date and location of the accident or hospitalization

- A description of the injury or illness

- The names of any hospitals or doctors providing treatment

- The amount of the medical bills and other expenses you have incurred

- Any other relevant information to support your claim

Upon submitting the form, Colonial will review the claim and make a prompt payment to you or directly to your healthcare provider.

**The following is a list of claims forms that may be of use to you.

- Accident or Illness Claim Form

- Disability Income Claim Form

- Supplemental Health Insurance Claim Form

- Life Insurance Claim Form

- Waiver of Premium Claim Form**