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.