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Forms Made Easy

Lang Insurance Service is always available Monday - Friday from 8:00 am to 5:00 pm to assist you. Please call us at 636-229-7000 to let us know how we can help. For your convenience, many of the forms you may need to add an employee, change contact information, etc. are provided below. Please contact us with any questions!

Form
Description
Form Type
Anthem Find a Provider
Instructions on how to find a provider.
Anthem Preventative Care
Information about preventative care guidelines and services.
Change Existing Policy
Request a change to an existing policy.
Coventry Find a Provider
Instructions on how to find a provider.
Coventry Preventative Care
Information about preventative care guidelines and services.
Dental Insurance Quote
Request a quote for Dental Insurance.
Individual Health Quote
Request a quote for Individual Health Insurance.
Life Insurance Quote
Request a quote for Life Insurance.
Long Term Care Quote
Request a quote for Long Term Care insurance.
Medicare Supplement Quote
Request a quote for Medicare Supplement insurance.
United Health Care Find a Provider
Instructions on how to find a provider.
United Health Care Preventative Care
Information about preventative care guidelines and services.
Update contact information
Update your contact information.
Form
Description
Form Type
Group Census Form
Provide employee information for a Group Health quote.
Downloadable Group Census Form
Provide employee information for a Group Health quote.
ADVANTICA
New hire, Open enrollment, etc.
Advantica Form
New hire, Open enrollment, etc.
ANTHEM
Anthem Change Form
Address change, Life Benefit, Life Class, Cancel/waive coverage, Benefit Change, Cancer Dependent, Name Change, Other.
Anthem Enrollment Form
New hires, Open enrollment, Qualifying event, COBRA, other.
Anthem Find a Provider
Instructions on how to find a provider.
Anthem International Medical Claim Form
File an international medical claim.
Anthem Life Only Application
Use for new hire.
Anthem Life with Medical
Applying for Life when coming on late (did not apply when first hired).
Anthem Medical Claim Form
File a medical claim.
Anthem Prescription Reimbursement Form
Use for requesting reimbursement for a prescription.
Anthem Preventative Care
Information about preventative care guidelines and services.
Anthem Termination Form
Use only if leaving company.
COVENTRY (GHP)
Coventry (GHP) Dental Enrollment Form
New hire, Open Enrollment, Qualifying event, COBRA, Addition, Address change, Termination
Coventry (GHP) Enrollment/Change Form
New hire, Open Enrollment, Qualifying event, COBRA, Addition, Address change, Termination.
Coventry Find a Provider
Instructions on how to find a provider.
Coventry Prescription Reimbursement
Use for requesting reimbursement for a prescription.
Coventry Preventative Care
Information about preventative care guidelines and services.
Coventry (GHP)Termination Report
Employees leaving group.
DELTA
Delta Dental
New application, Changes, COBRA.
HUMANA
Humana
Enrollment for Dental, Vision & Life.
LINCOLN LIFE
Lincoln Life
Life application.
UNITED HEALTH CARE
United Health Care Form
New hire, Open enrollment, Qualifying event, Waiving, PDF Adding, Cancel dependent, Add dependent, Termination, Other.
United Health Care Find a Provider
Instructions on how to find a provider.
UHC Prescription Reimbursement Form
Use for requesting reimbursement for a prescription.
United Health Care Preventative Care
Information about preventative care guidelines and services.
UNUM
Unum Life
Life application.
Form
Description
Form Type
Auto Accident Report Form
Keep this form in your glove compartment to use in case of an accident.
Auto Insurance Quote
Request a quote for Auto Insurance.
Boat Insurance Quote
Request a quote for Boat Insurance.
Camper/RV Insurance Quote
Request a quote for Camper/RV Insurance.
Change Existing Policy
Request a change to an existing policy.
Classic Car Insurance Quote
Request a quote for Classic Car Insurance.
Condo Insurance Quote
Request a quote for Condo Insurance.
Dwelling Fire Quote
Request a quote for Dwelling Fire Insurance.
Flood Insurance Quote
Request a quote for Flood Insurance.
Home Insurance Quote
Request a quote for Home Insurance.
Home Inventory
Use this form to make an inventory of items in your home
Life Insurance Needs Calculator
Helps to determine amount of Life Insurance needed.
Motorcycle Insurance Quote
Request a quote for Motorcycle Insurance.
Order Auto ID Cards
Request additional Auto policy ID cards.
Renters Insurance Quote
Request a quote for Renters Insurance.
Umbrella Insurance Quote
Request a quote for Umbrella Insurance.
Update Contact Information
Update your contact information.
Form
Description
Form Type
Business Insurance Quote
Request a quote for Business Insurance.
Change Existing Policy
Request a change to an existing policy.
Request a Certificate of Insurance
Request a certificate of insurance.
Update Contact Information
Update your contact information.