Downloads

Welcome to the downloadable forms resource page. Files are available in PDF format to be downloaded, printed and mailed accordingly. Acrobat Reader is a free application that can be downloaded at adobe.com/reader/.

Document Name Description Details
Cancer Care Enrollment Form California Residents Only Download Form (522k PDF)
Cancer Care Enrollment Form Wisconsin Residents Only Download Form (556k PDF)
Cancer Care Enrollment Form Country Wide Application Download Form (560k PDF)
Disability Income Enrollment Form California Residents Only Download Form (120k PDF)
Disability Income Enrollment Form New York Residents Only Download Form (152k PDF)
Disability Income Enrollment Form Country Wide Application Download Form (107k PDF)

Mail all claim forms to the following address:

AGIA Affiliate Services
Claims Department
P.O. Box 9060
Phoenix, AZ 85068