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Life/Voluntary Life
Click on type of form you need to see listing of forms
Claim Forms
Beneficiary Changes
Request for Assignment
Waiver of Premium
Accelerated Benefit Summary of Coverage
Conversion Privilege
Portability Request
State Variations
Claim Forms
Notice of Claim Proof of Death: Employer Statement
Notice of Claim Proof of Death: Claimant Statement
Notice of Claim Proof of Employee's Accidental Dismemberment
Notice of Claim Proof of Dependent’s Accidental Dismemberment
Notice of Claim for Accelerated/Living Benefit
Voluntary Accounts Only: Notice of Claim for accidental dismemberment loss if former employees continued coverage under portability provision.
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Beneficiary Changes
Instructions for naming a beneficiary
Change of Beneficiary Form
Voluntary Accounts Only: Change of Beneficiary Form for former employees who continued coverage under portability provision
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Request for Assignment
Form employees should use to assign his or her life insurance benefit
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Waiver of Premium
Group Accounts Only – Request for Extended Life Insurance - Waiver of Premium
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Accelerated Benefit Summary of Coverage
For Employers: Explains Accelerated Benefit of six month duration
For Employers: Explains Accelerated Benefit of 12 month duration
For Employees: Explains Accelerated Benefit of six month duration
For Employees: Explains Accelerated Benefit of 12 month duration
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Conversion Privilege
Life Conversion Notice
Conversion Kit
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Portability Request
Portability Request - This form gives a terminating employee the chance to apply to keep his or her life insurance after employment ends.
Voluntary Accounts Only – Portability Life & AD&D Benefit Change Request
Voluntary Life Only - Legacy Portability Letter
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State Variations
CT - Connecticut
CT Employer Summary of Coverage for Accelerated Benefit Option
KS - Kansas
KS Employer Summary of Coverage for Accelerated Benefit Option
MA - Massachusetts
MA Employer Summary of Coverage for Accelerated Benefit Option
MA Employee Summary of Coverage for Accelerated Benefit Option
MN - Minnesota
MN Cancellation Notice requires employer to provide written notice to employees about cancellation of plan
MN Notice of Continuance of Group Life coverage if family or employment status changes
MN Continuance Form. Employer and employee need to complete form to continue coverage if family or employment status changes
MN Employer Summary of Coverage for Accelerated Benefit Option
MS - Mississippi
MS Employer Summary of Coverage for Accelerated Benefit Option
MS Employee Summary of Coverage for Accelerated Benefit Option
NJ - New Jersey
NJ Instructions about Complaint and Internal Appeals Process for Life Insurance Claims
NJ Employer Summary of Coverage for Accelerated Benefit Option
NJ Employee Summary of Coverage for Accelerated Benefit Option
NC - North Carolina
NC Insurance Fiduciary Notice to employers of their responsibilities
PA - Pennsylvania
PA Employer Summary of Coverage for Accelerated Benefit Option
UT - Utah
UT Notice of Termination of Life Coverage. Requires employer to notify employees of termination of plan
VA - Virginia, WI
VA Employer Summary of Coverage for Accelerated Benefit Option
VA Employee Summary of Coverage for Accelerated Benefit Option Wisconsin
WA - Washington
WA Employer Summary of Coverage for Accelerated Benefit Option
WA Employee Summary of Coverage for Accelerated Benefit Option
For use with True Group (non-MET) cases only
KS Employer Summary of Coverage for Accelerated Benefit Option
MN Employer Summary of Coverage for Accelerated Benefit Option
MS Employer Summary of Coverage for Accelerated Benefit Option
NJ Employer Summary of Coverage for Accelerated Benefit Option
NJ Employee Summary of Coverage for Accelerated Benefit Option
PA Employer Summary of Coverage for Accelerated Benefit Option
VA Employer Summary of Coverage for Accelerated Benefit Option
VA Employee Summary of Coverage for Accelerated Benefit Option Wisconsin
WA Employer Summary of Coverage for Accelerated Benefit Option
For use with all groups
CT Employer Summary of Coverage for Accelerated Benefit Option
MA Employer Summary of Coverage for Accelerated Benefit Option
MA Employee Summary of Coverage for Accelerated Benefit Option
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