Forms

First Financial Group of America manages all supplemental benefits and insurances except medical. If you need a form to file a claim with one of these other insurances, please click the link below: 

First Financial Group of America


Below are links to our Disability Claim Forms.  Please DO NOT fill ANY information in the EMPLOYER portions of these forms. Once they are completed, you will send them to us. We will submit them to the insurance company for you.

(tool tip...if the forms below open in a new window and nothing appears, open your downloads folder on your computer, right-click on the form and "Open With" Adobe Acrobat.)

AF Long-term Disability Claim Form.pdf

Manhattanlife Maternity Disability Claim Form 121823.pdf

Manhattan Life Short Term Disability Claim Form 121823.pdf

For all of these forms, please fill your portion of the claim out, have your physician fill the physician portion out and return the ENTIRE form to this office at [email protected] or [email protected].


Looking for your Guardian Cancer Wellness Screening Benefit Claim Form? Guardian Cancer Wellness Screening Form.pdf

Adding/Dropping a dependent or spouse to/from your health plan? You will need to complete an enrollment form.

OGB Enrollment/Change Form 09/2023(GB01)  (tool tip...if the form opens in a new window and nothing appears, open your downloads folder on your computer, right-click on the form and "Open With" Adobe Acrobat.)

OGB Pelican HSA775 Contribution Form


Need help calculating your HSA contribution, here is a link to Health Equity to help you do that. 
                                             HSA Contribution Calculator



Looking for the Catapult Health PCP form?  Click this link:  Catapult Health PCP Form