Forms

Forms

Forms

Important forms to apply for and manage your coverage.

Forms

 

Below are important forms to apply for or to manage your coverage.


These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing. Click here to download a free copy of Adobe Acrobat Reader.

  • Voluntary Term Life

    Application Form

    You can apply online for new coverage or increase existing coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

     

    Beneficiary Form

    Review and update your current beneficiary designations online in My Account. You may wish to complete a paper Beneficiary Designation form to make your designation, particularly if you have estate tax considerations or have needs that are more complicated that this online system allows. We strongly encourage you to consult the legal advice of an attorney in these instances. If you submit your beneficiary designation via a paper form, we will enter it into the NYL GBS Benefits Guide website so you can view it online through “My Account”.

     

    Domestic Partner Proof

    In order to file a claim for benefits, proof of the domestic partnership must be furnished the same as proof of a marriage. The definition and requirements of Domestic Partnership can be found on the Voluntary Term Life Products page under the General Definitions section.

     

    Request for Change Form

    Use this form to make changes to the features and benefits of your VTL (other than increasing coverage), including reducing your coverage or cancelling coverage for your children

     

    Surrender/Cancel Form

    Use this form to cancel/surrender VTL coverage for You and/or your Spouse/Domestic Partner

     

    Claim Forms

    The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

     

    Return completed VTL claim forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

     

    Voluntary Term Life Claim Form
    Accelerated Payment Benefit Claim Form

  • Accidental Death & Dismemberment

    Application Form

    You can apply online for new coverage or increase existing coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

     

    Beneficiary Form

    Review and update your current beneficiary designations online in My Account. You may wish to complete a paper Beneficiary Designation form to make your designation, particularly if you have estate tax considerations or have needs that are more complicated that this online system allows. We strongly encourage you to consult the legal advice of an attorney in these instances. If you submit your beneficiary designation via a paper form, we will enter it into the NYL GBS Benefits Guide website so you can view it online through “My Account”.

     

    Domestic Partner Proof

    In order to file a claim for benefits, proof of the domestic partnership must be furnished the same as proof of a marriage. The definition and requirements of Domestic Partnership can be found on the Voluntary Term Life Products page under the General Definitions section.

     

    Request for Change Form

    Use this form to make changes to the features and benefits of your AD&D, including reducing your coverage or changing from Employee Only to Employee + Family coverage.

     

    Surrender/Cancel Form

    Use this form to cancel/surrender AD&D coverage for You and/or your Family

     

    Claim Forms

    The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

     

    Return completed AD&D Claim Forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

  • Disability

    Application Form

    You can apply online for new coverage or increase existing coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

     

    Surrender/Cancel Form

    Use this form to cancel/surrender Disability coverage

     

    Claim Forms

    The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.

     

    Return completed claim forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

     

    Long-Term Disability Claim Form
    Long-Term Disability Disclosure Authorization Form

  • How/Where to Return Forms

     

    Completed Beneficiary Forms or Change Forms can be returned to the NYL GBS Customer Service Center:

     

     

    Completed Claim Forms can be returned to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193.