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Voluntary Benefit Programs

 
How To File A Claim

Life Insurance and Accidental Death Benefits

  • The Trust Office must be notified when a covered individual dies.
  • The Beneficiary (or the Beneficiary's authorized representative) must complete and submit IRS Form W-9 (Request for Taxpayer Identification Number and Certification) and a certified copy of the Death Certificate to the Trust Office. If the Beneficiary is a Trust, a copy of the Trust instrument and all amendments, if applicable, must also be submitted to the Trust Office.
  • In the case of an Accidental Death claim, an Autopsy Report and Toxicology Report must also be submitted to the Trust Office.
  • Upon notification and receipt of the required documentation, the Trust Office will complete the necessary forms and transmit them together with the required documentation to Pacific Guardian Life.

Accidental Dismemberment or Loss of Sight Benefits

  • You must complete and submit a Claim for Group Accidental Dismemberment or Loss of Sight Benefits form to the Trust Office.
  • Upon receipt of the required documentation, the Trust Office will transmit your claim to Pacific Guardian Life.

Short-Term Income Protection Insurance Benefits

Written Proof of Loss must be sent to American Fidelity Assurance Company at 2000 North Classen Boulevard, Oklahoma City, Oklahoma 73106, or to the Trust Office. Such Proof of Loss should be made within 30 days after any loss covered by the Plan. If it is not reasonably possible to give Proof of Loss within that time, your claim may not be denied or reduced due to the delay. Proof of Loss, provided at your expense, must show:

  1. That you are under the regular and appropriate care of a physician;
  2. The date your Disability began;
  3. The cause of your Disability;
  4. The appropriate documentation of your monthly compensation;
  5. The extent of your Disability, including restrictions and limitations preventing you from performing your regular occupation; and
  6. The name and address of any hospital or institution where you received treatment, including all attending physicians.

Proof of Loss must be sent to American Fidelity within 90 days after the loss. Late Proof of Loss may be accepted if it was not reasonably possible to give proof within 90 days and the Proof of Loss is given within 1 year from the date of loss. This 1-year limit will not apply in the absence of legal capacity.

Long-Term Income Protection Insurance Benefits

If you become Totally Disabled:

  • Notify the HSTA Voluntary Employees Beneficiary Association Trust Office as soon as possible. Written notice of your claim must be provided to the Hartford within 30 days after you become disabled. A claim form for providing Proof of Loss will then be sent to you. Proof of Loss may include but not be limited to documentation of your disability, your earnings or income, and medical information.
  • You, your physician, and your employer must complete the claim form. The completed claim form is to be sent to the HSTA Voluntary Employees Beneficiary Association Trust Office who will forward the claim form to The Hartford. Written Proof of Loss must be sent to the Hartford within 90 days after the start of your disability.

Long Term Care Insurance Benefits

If you become Disabled, you must fill out a Long Term Care Claim Form and send it to UNUM. Claim forms are available from the Trust Office. You must send UNUM the claim form no later than 90 days after the date you become Disabled or as soon as it is reasonably possible to do so, but in no event more than one (1) year after the time this proof is required.

You will be required to give UNUM information on your continued Disability, when requested. UNUM may also require a claims assessment, which is a review done by UNUM to help in evaluating the Disability. A face-to-face interview or examination by a Physician may also be required. If required, however, UNUM will pay for the cost of the interview or examination.

Critical Illness Insurance Benefits

You can designate another person to act on your behalf in the handling of your benefit claims. In order to do so, you must complete and file a form with the Trust Office and/or the insurance carrier that identifies the individual that is authorized to act on your behalf as your authorized representative. If you designate an authorized representative to act on your behalf, all correspondence and benefit determinations will be directed to your authorized representative, unless you direct otherwise. You may also request that this information be provided to both you and your authorized representative.

To file a claim for benefits, notice of the claim and proof of the claim must be submitted as follows:

  • Step 1: You must give notice by writing or calling MetLife within 30 days of the date of your loss.
  • Step 2: MetLife will send you a claim form and instructions on how to complete it. You should receive the form within 15 days of giving notice of your claim.
  • Step 3: When you receive the claim form, you should fill it out as instructed and return it with the required proof of claim.
  • Step 4: You must provide proof of your claim within 90 days of the date of your loss. If notice or proof of your claim is not given within the time limits described, the delay will not cause a claim to be denied or reduced if such notice and proof are given as soon as reasonably possible, but in no event later than 15 months from the date of your loss.

Your Certificate of Coverage contains specific proof requirements for covered conditions. You may be required to also provide authorization for MetLife to obtain medical records and other information pertinent to your claim and/or be examined by an independent physician at the Company’s expense.

For assistance in filing a claim or if you have any questions regarding claims and appeals procedures, contact the Trust Office or a MetLife Customer Service representative toll-free at 1-800-438-6388, Monday through Friday between 8:00 a.m. and 11:00 p.m. Eastern Standard Time. You may also write to

MetLife at the following address:

Metropolitan Life Insurance Company
Critical Illness Insurance Department
P.O. Box 6120
Scranton, PA 18505-9972

Contact Trust Office
regarding questions about your benefits

Telephone NumberCustomer Support
(808) 440-6940 (Oahu)
(800) 637-4926
(toll free from Neighbor Islands)

ContactTrust Office
Contact by Email

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1259 Aala St., Ste 202
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