Skip to main content

Your web browser is out-of-date. For the best experience, please update to a modern browser like Chrome, Edge, Safari or Mozilla Firefox.

Apply for a non-smoker rate

Have coverage through your employer or plan sponsor? You’re in the right place.

If you bought coverage through an advisor, use our personal insurance forms instead.

Make a change

Use this form to apply for a non-smoker rate if you have life insurance as part of your workplace benefits. 

You'll find instructions on how to return the completed form on the form itself.

Download the form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save. 

Not what you’re looking for? Find the forms you need.

I have coverage through my employer

Find a form

I bought coverage through an advisor

Find a form