Life insurance premium waiver due to disability forms
How to make a claim
If you have coverage through your employer or plan sponsor, use these forms to apply to waive your workplace life insurance premium if a disability is keeping you from working.
To make a claim:
Step 1: Download the life insurance waiver form package.
You can print it and fill it out by hand, or complete it digitally in Adobe Reader XI or higher - Opens in a new window (not your browser).
Step 2: Complete all 3 sections of the package.
You can complete both the consent section and employee section yourself, but you will need to ask your doctor to fill out the section labelled “Physician’s report.”
Step 3: Submit your claim.
You can send this package by email or fax to your disability management services office. Check with your employer to find out which office has been assigned to your claim.
In light of COVID-19, we ask that you do not mail these forms to us.