Important forms to apply for and manage your coverage.
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
Voluntrary Term Lfe 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.