Forms

Medical and Dental

Prescription Drug

Vision

Private Health Authorization Form

Retirement

Life Insurance and Accidental Death & Dismemberment

Visit www.lifebenefits.com to enroll and to elect your beneficiaries.


Group Universal Life (GUL) Service Request Form

This form is used to decrease or cancel GUL coverage or to elect, change or cancel GUL cash accumulation contributions. Go to www.lifebenefits.com to make changes to your GUL coverage.
 

Conversion Form

This form is used if you plan to be the owner of your child’s life insurance policy if you leave the company. Go to www.lifebenefits.com to apply for a conversion of this policy.
    

Life Insurance Conversion Form.

This form is used to continue life insurance if you retire or leave the company. Go to www.lifebenefits.com to apply for a conversion of this policy.