By clicking on one of the choices below, you may print the form on your computer’s printer.

These forms apply to any policy:

Pay Provider Direct
If you would like for us to pay the provider directly, please use this form.

HIPAA Authorization
If you would like to designate a person or persons to receive information about your policy or claims, please use this form.

If you have any questions, please call 888-616-0015.

If you need to update your Personal Information, Policy Information, or to request duplicate documents, all you need to do is select from the options below.

Simply Download, Print, and Send:

Duplicate ID Card
Duplicate Policy
Name Change
Address Change
Beneficiary Change

Fax: 336-759-3141
Mailing Address:
P. O. Box 11903, Winston-Salem, NC 27116

If you have other questions or need further assistance, contact your Heartland National Agent.

If you cannot reach your Heartland agent, please contact a policyowner service representative. We will be glad to assist you. Please call our toll free number at 1-888-616-0015.