{"id":1362,"date":"2022-10-10T21:11:04","date_gmt":"2022-10-10T21:11:04","guid":{"rendered":"https:\/\/us.tolic.com\/home-empresas-en\/forms\/"},"modified":"2024-09-18T15:31:37","modified_gmt":"2024-09-18T15:31:37","slug":"forms","status":"publish","type":"page","link":"https:\/\/us.tolic.com\/en\/forms\/","title":{"rendered":"Forms"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1362\" class=\"elementor elementor-1362 elementor-540\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c3bec40 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c3bec40\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-259fc64c\" data-id=\"259fc64c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4875c389 elementor-widget elementor-widget-heading\" data-id=\"4875c389\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Forms<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6625f4d5 elementor-widget elementor-widget-text-editor\" data-id=\"6625f4d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>For your convenience, all our claims and services forms are available online.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-400ce779 elementor-align-left elementor-mobile-align-center elementor-widget elementor-widget-button\" data-id=\"400ce779\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/us.tolic.com\/en\/contact-us\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">CONTACT US<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1b32a9c7 elementor-hidden-mobile\" data-id=\"1b32a9c7\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5ea67ae6 tab1 tab-content  tab-content--active elementor-section-boxed elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"5ea67ae6\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2306ad34\" data-id=\"2306ad34\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-146f0fa1 elementor-widget elementor-widget-heading\" data-id=\"146f0fa1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Claims Forms<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-561954ff elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"561954ff\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-3623abe0\" data-id=\"3623abe0\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-ea7682d elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"ea7682d\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-764fb42\" data-id=\"764fb42\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-952f9c1 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"952f9c1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/FL-Accident-Claim-Rev-052021.pdf\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" width=\"52\" height=\"81\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/accidente.png\" class=\"attachment-full size-full wp-image-1196\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/FL-Accident-Claim-Rev-052021.pdf\" target=\"_blank\">Accident <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-c1433cd\" data-id=\"c1433cd\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-c2f9b10 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"c2f9b10\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-5dfb45c\" data-id=\"5dfb45c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a44c707 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"a44c707\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/FL-Claim-for-Illness-Rev-052021.pdf\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" width=\"69\" height=\"82\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/prostate-cancer.png\" class=\"attachment-full size-full wp-image-1197\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/FL-Claim-for-Illness-Rev-052021.pdf\" target=\"_blank\">Cancer \/ Illness <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-2f36b519\" data-id=\"2f36b519\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-e44b02c elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"e44b02c\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-e7cc53d\" data-id=\"e7cc53d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6a9dc259 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"6a9dc259\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/FL-Claim-for-Prevention-Rev-052021.pdf\" target=\"_blank\" tabindex=\"-1\"><img decoding=\"async\" width=\"82\" height=\"83\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/prueba-en-linea.png\" class=\"attachment-full size-full wp-image-1198\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/FL-Claim-for-Prevention-Rev-052021.pdf\" target=\"_blank\">Preventive Testing <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-7b3446e1 elementor-hidden-mobile\" data-id=\"7b3446e1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-56d9a861 elementor-hidden-mobile\" data-id=\"56d9a861\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-47dab07c elementor-hidden-mobile\" data-id=\"47dab07c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8c8ec7 tab1 tab-content  tab-content--active elementor-section-boxed elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"8c8ec7\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-49e2fb37\" data-id=\"49e2fb37\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-711b1833 elementor-widget elementor-widget-heading\" data-id=\"711b1833\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Services Forms<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-497ca648 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"497ca648\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-4e7a8af\" data-id=\"4e7a8af\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-ab26c10 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"ab26c10\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-335999c\" data-id=\"335999c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0148833 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"0148833\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Beneficiary-Designation-Request-Form-Rev-012023.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"84\" height=\"83\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/correccion.png\" class=\"attachment-full size-full wp-image-1202\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Beneficiary-Designation-Request-Form-Rev-012023.pdf\" target=\"_blank\">Change of Beneficiary Designation <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-50b6521e\" data-id=\"50b6521e\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-704e9e6 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"704e9e6\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-b3cc114\" data-id=\"b3cc114\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-547e9b2 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"547e9b2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Coverage-Change-Request-Form.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"74\" height=\"81\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/sello.png\" class=\"attachment-full size-full wp-image-1203\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Coverage-Change-Request-Form.pdf\" target=\"_blank\">Change <br>of Coverage <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-27f1caf4\" data-id=\"27f1caf4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-ef66f21 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"ef66f21\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-2443e81\" data-id=\"2443e81\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d046395 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"d046395\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Payer-Change-Request-Form.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"91\" height=\"79\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/cuenta.png\" class=\"attachment-full size-full wp-image-1204\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Payer-Change-Request-Form.pdf\" target=\"_blank\">Change <br>of Payer <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-580fd121\" data-id=\"580fd121\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-92046c4 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"92046c4\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-ecf21b4\" data-id=\"ecf21b4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-aa673dd elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"aa673dd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Name-Correction-Request-Form.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"68\" height=\"80\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/perfiles.png\" class=\"attachment-full size-full wp-image-1205\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Name-Correction-Request-Form.pdf\" target=\"_blank\">Name Correction <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-280876b2\" data-id=\"280876b2\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-45c87ff elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"45c87ff\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-01dc9d1\" data-id=\"01dc9d1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8178c56 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"8178c56\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Dependent-Inclusion-Request-Form.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"81\" height=\"81\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/documento.png\" class=\"attachment-full size-full wp-image-1206\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Dependent-Inclusion-Request-Form.pdf\" target=\"_blank\">Inclusion of Dependent <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-5a7808ee\" data-id=\"5a7808ee\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-a00dd8d elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"a00dd8d\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-90f9a75\" data-id=\"90f9a75\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-732b222 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"732b222\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Payment-Method-Change-Request-Form.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"57\" height=\"81\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/cifrado.png\" class=\"attachment-full size-full wp-image-1207\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Payment-Method-Change-Request-Form.pdf\" target=\"_blank\">Eliminate Dependents <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7fe5cf7a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7fe5cf7a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-452d4e35\" data-id=\"452d4e35\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-fcc7579 elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"fcc7579\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-9fb6898\" data-id=\"9fb6898\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-991e480 elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"991e480\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2023\/04\/Payment-Method-Change-Request-Form-3.14.2023.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"74\" height=\"81\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/archivo.png\" class=\"attachment-full size-full wp-image-1208\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2023\/04\/Payment-Method-Change-Request-Form-3.14.2023.pdf\" target=\"_blank\">Change of <br>Payment Method <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-bd5bd4f\" data-id=\"bd5bd4f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-8da6b3a elementor-section-height-min-height elementor-section-content-middle elementor-section-boxed elementor-section-height-default\" data-id=\"8da6b3a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-10d73f9\" data-id=\"10d73f9\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4a9039c elementor-position-top elementor-widget elementor-widget-image-box\" data-id=\"4a9039c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><figure class=\"elementor-image-box-img\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Reinstatement-Request.pdf\" target=\"_blank\" tabindex=\"-1\"><img loading=\"lazy\" decoding=\"async\" width=\"84\" height=\"83\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/correccion.png\" class=\"attachment-full size-full wp-image-1202\" alt=\"\" \/><\/a><\/figure><div class=\"elementor-image-box-content\"><h3 class=\"elementor-image-box-title\"><a href=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2024\/09\/Reinstatement-Request.pdf\" target=\"_blank\">Reinstatement <br>Application <i aria-hidden=\"true\" class=\"fas fa-download marked\"><\/i><\/a><\/h3><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-63bfdc9f elementor-hidden-mobile\" data-id=\"63bfdc9f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-67d87142 elementor-hidden-mobile\" data-id=\"67d87142\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-3f64eac4 elementor-hidden-mobile\" data-id=\"3f64eac4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-50e42069\" data-id=\"50e42069\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-59c88892 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"59c88892\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-1dc98a\" data-id=\"1dc98a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1c2565fc elementor-widget elementor-widget-image\" data-id=\"1c2565fc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"50\" height=\"56\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/objeto-inteligente-vectorial.png\" class=\"attachment-large size-large wp-image-1166\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6c6a1763 elementor-widget elementor-widget-text-editor\" data-id=\"6c6a1763\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #008390;font-weight: 900;font-size: 18px\">Service hours<\/span><br \/><strong>Monday to Friday<\/strong><br \/>8:00 a. m. to 5:00 p. m.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-22e18d2c\" data-id=\"22e18d2c\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5bb026fe elementor-widget elementor-widget-image\" data-id=\"5bb026fe\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"75\" height=\"56\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/objeto-inteligente-vectorial2.png\" class=\"attachment-large size-large wp-image-1167\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-373e3cd elementor-widget elementor-widget-text-editor\" data-id=\"373e3cd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<a href=\"tel:+1-407-664-1703\">407-664-1703<\/a><br>\n<a href=\"tel:1-800-981-8662\">1-800-981-8662<\/a>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-790f0a21\" data-id=\"790f0a21\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-34ff8f52 elementor-widget elementor-widget-image\" data-id=\"34ff8f52\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"56\" height=\"56\" src=\"https:\/\/us.tolic.com\/wp-content\/uploads\/sites\/5\/2022\/10\/objeto-inteligente-vectorial1.png\" class=\"attachment-large size-large wp-image-1168\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-58a7522 elementor-widget elementor-widget-text-editor\" data-id=\"58a7522\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #008390;font-weight: 900;font-size: 18px\">&#99;&#x75;s&#116;&#x6f;m&#101;&#x72;s&#101;&#x72;v&#105;&#x63;e&#64;&#x74;o&#108;&#x69;c&#46;&#x63;o&#109;<\/span><br \/>Email us to contact a <strong>customer service representative.<\/strong><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Forms For your convenience, all our claims and services forms are available online. CONTACT US Claims Forms Accident Cancer \/ Illness Preventive Testing Services Forms Change of Beneficiary Designation Change of Coverage Change of Payer Name Correction Inclusion of Dependent Eliminate Dependents Change of Payment Method Reinstatement Application Service hoursMonday to Friday8:00 a. m. to [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1362","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Forms - TOLIC USA<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/us.tolic.com\/en\/forms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Forms - TOLIC USA\" \/>\n<meta property=\"og:description\" content=\"Forms For your convenience, all our claims and services forms are available online. 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