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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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