Medicare Supplement Forms
Lincoln Heritage Life Insurance Company provides the following forms to be downloaded in Adobe PDF format. If you do not currently have Adobe Acrobat reader, then you can download a free copy of it by clicking on the icon below.
Select a form from the list:
Change Bank Draft / Pre-Authorized Checking
Duplicate Policy
For Reinstatement Applications, click here.
To request a new Medicare Supplement ID Card, please Contact Us and request a new ID card by e-mail or telephone.
In order to verify your identity and safeguard your interests, we require a printed and signed form before any changes or requests can be made to your policy. In some cases, we do ask that the form be notarized as well. You may return the forms by mail or fax.
By Mail:
Lincoln Heritage Life Insurance Company
Attn: Policyholder Service
PO Box 29045
Phoenix, AZ 85038
By Fax:
Policyholder Service Department
1-602-224-2247
For all other service requests, please contact us toll-free at 1-800-287-7319.
Lincoln Heritage Life Insurance is not connected with or endorsed by the U.S. Government or the federal Medicare program.
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