REQUEST A QUOTE 1.855.774.4495 | Make A Claim | Forms | Careers Policyholder Forms Annuity-Repetitive Pay Option Form Application for Reinstatement Beneficiary Change form Bank Authorization form Change of Ownership form Duplicate Policy Request Name Change Affidavit Policy Loan Request form Request for Reduced Paid Up Insurance form UL Loan Request form CA state surrender form Generic Surrender form KY state surrender form OR state surrender form WA state surrender form Life Insurance Claim Form Home About Us Our Policy Products News + Announcements Contact Make A Claim Forms Request a Quote Careers Neither State Mutual Insurance Company nor its Medicare Supplement Insurance Policies are connected with or endorsed by the U.S. Government. A licensed agent may contact you. CONTACT US! 210 East Second Ave, Suite 301 Rome, Georgia 30161 Post Office Box 153 Rome, Georgia 30162-0153 Corporate Office | 706-291-1054 Life Insurance | 833-508-0404 Medicare Supplement | 877-872-5500 Platinum Supplement | 877-822-0582 ©2021State Mutual Insurance Company Terms Of Use | Privacy Statement

REQUEST A QUOTE 1.855.774.4495 | Make A Claim | Forms | Careers Make A Claim To make a Platinum Supplemental Health Claim, please click here. You will be directed to the website of our marketing partner Platinum Supplemental Insurance. Their customer service specialists can help you with any questions and walk you through the process of filing your claim. You may reach them directly at 1-855-774-4495 – Monday through Thursday from 8 am-5pm (EST) and on Fridays from 8am-1pm (EST). To make a Life Insurance Claim, please click here for a PDF form that can be downloaded and printed. Once completed, mail the form to our State Mutual Insurance claims office at P.O. Box 11864, Winston-Salem, NC, 27116. Home About Us Our Policy Products News + Announcements Contact Make A Claim Forms Request a Quote Careers Neither State Mutual Insurance Company nor its Medicare Supplement Insurance Policies are connected with or endorsed by the U.S. Government. A licensed agent may contact you. CONTACT US! 210 East Second Ave, Suite 301 Rome, Georgia 30161 Post Office Box 153 Rome, Georgia 30162-0153 Corporate Office | 706-291-1054 Life Insurance | 833-508-0404 Medicare Supplement | 877-872-5500 Platinum Supplement | 877-822-0582 ©2021State Mutual Insurance Company Terms Of Use | Privacy Statement