Adobe Reader XI or higher is required to fill out and save a completed form. Download Adobe ReaderOpens a new website in a new window.
Use these forms to apply to waive your group life insurance premium if a disability is keeping you from working.
To make a claim, download the life insurance waiver form package on this page. You can print it and fill it out by hand, or complete it digitally in Adobe Reader (not your browser).
There are 3 sections you’ll need to complete:
- Consent form – You’ll need to complete this form in full.
- Employee statement – You’ll need to complete this form in full, with some details from your employer.
- Physician’s report – You’ll need to ask your doctor to fill this out.
Submit your claim 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.
Not forms you're looking for? Go back to the find a form page.