Forms

The Claim Forms and Beneficiary Designation Forms are accessible below, separately for the counties and cities.

Claims may be reported on or after the effective date of coverage, which is no sooner than January 1, 2025. See the Claims Service tab for more information on submitting a claim.

ACCG-IRMA (Counties)

• ACCG Critical Illness Claim Form (Lump Sum)
• ACCG Long-Term Disability Claim Form
• ACCG First Responder Acknowledgments Form
• ACCG Beneficiary Designation Form (Coming Soon!)

GMA-GIRMA (Cities)

• GMA Critical Illness Claim Form (Lump Sum)
• GMA Long-Term Disability Claim Form
• GMA First Responder Acknowledgments Form
• GMA Beneficiary Designation Form (Coming Soon!)