Claim Forms
Request for Specific Excess Loss Reimbursement
Prospective Claim Notification
Request for Aggregate Reimbursement
Email or Fax submissions to RLJClaims@Rljinsurance.com
866.454.0768
Other Forms
Stop Loss Request for Proposals (RFP)
MGU Premium Remittance Report
Email or Fax submissions to RLJRFP@RLJinsurance.com
866.454.0768
Independent Broker’s Agreement
W-9
Email or Fax submissions to RLJaccounting@RLJinurance.com
866.454.0768
Instructions
Guide to Identifying Trigger Diagnosis
High Cost Pharmaceuticals
Aggregate Claim Request Instructions
Instructions for Prospective Claim Notification
Reports Required for Aggregate
