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Life-Accident
Forms

Forms

Below are some forms that you may need as part of your enrollment in this benefit. Please see the Life and AD&D SPD  for details.
 

Accelerated Benefit

You will need to complete the Accelerated Benefit Form  to provide the insurance carrier with satisfactory written proof that you have a terminal condition and wish to receive the proceeds of your group life insurance.  If you qualify, you can elect to receive any amount up to the maximum Accelerated Benefit.  

 

Conversion of Group Life Insurance

This form is used to buy dependent or individual permanent life insurance policy during the conversion period without submitting an evidence of insurability, if you meet certain criteria.  Life Insurance Conversion Form.  

 

Dependent Claim Form

This form is needed when you want to claim the proceeds of the dependent life insurance polcy.  Dependent Claim Form

 

Evidence of Insurability

This form is used when you do not enroll or elect the maximum benefits for yourself and your dependents when first eligible to do so and want to add or increase coverage at a later date.  Evidence of Insurability Form You must provide evidence of insurability and be approved by the insurance carrier prior to adding or increasing your coverage. This form is necessary to increase your coverage more than one level during the Annual Enrollment period. 

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