Group Accident Medical Brochures and Forms
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Accident Medical Brochures, Claim and ACH Forms

GrouProtectorSM brochures and applications

Learn more about GrouProtector and get an application:

Get accident medical ACH forms

Using an ACH (Automated Clearing House) form is a convenient way to pay initial premiums, policy endorsements and even routine bills.

To make a single payment from a checking or savings account, complete the appropriate ACH form and submit it along with your new application, billing statement or policy endorsement. Remember, account and routing numbers are required to process the payment. 

Nationwide policies

To issue premium payment for a Nationwide policy instead of mailing a check or money order, use the Nationwide ACH form.

National Casualty policies

To issue premium payment for a National Casualty Company (a division of Scottsdale Insurance) policy, please use the National Casualty ACH Form.

Fax completed ACH forms and any supporting documentation detailing the premium due to: 
1-413-214-7761 
Attention: Policy Administration