Get Unum Cl-1090 2013-2025

This guide provides clear and detailed instructions on how to effectively complete the Unum CL-1090 online. Whether you are submitting health screening or wellness benefit claims, this step-by-step guide will assist you in navigating the necessary fields.

Follow the steps to complete the Unum CL-1090 form online.

1. Click ‘Get Form’ button to obtain the form and access it for completion.
2. Fill in the insured's information, including last name, date of birth, suffix, first name, middle initial, social security number, gender, home address, and contact numbers.
3. Provide details about the patient. Indicate the relationship by selecting 'Self,' 'Spouse,' 'Domestic Partner,' or 'Child.' Include the patient's last name, first name, middle initial, date of birth, social security number, gender, and address.
4. Complete the health screening/wellness benefit claim section by checking all applicable tests performed and entering the corresponding dates.
5. Review the tax considerations statement and determine if you require independent tax advice based on your situation.
6. Sign and date the form, ensuring to read and understand the fraud notices provided. If signing on behalf of the insured, indicate your relationship.
7. If applicable, complete the optional authorization section to permit Unum to share information with designated third parties. Provide details and sign as required.
8. Once all sections are accurately filled out, save your changes. You can then download, print, or share the completed form as needed.

Complete your Unum CL-1090 form online today to ensure your health screening and wellness benefits are processed efficiently.