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Waiver Premium Form

Waiver Premium Form

Use a waiver premium form template to make your document workflow more streamlined.

The form, including the instruction sheet, to your employee. Ask him/her to complete the Employee Sections and return the claim form to The Hartford. (Your employee should detach the Attending Physician's Statement ­ Initial Report [Attending Physician Statement], pages 1 and 2, and forward to his/her physician for completion). 5. SUBMIT THE EMPLOYER'S STATEMENT AND ATTACHMENTS DIRECTLY TO THE HARTFORD BEFORE THE CLAIM SUBMISSION PERIOD* SPECIFIED UNDER THE POLICY. ** Please verify if the...
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