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[Section 1 - Health] Information - [ For Life AD D Disability . . . 1 Life Insurance may include an Accelerated Benefits Option under which a terminally ill insured can accelerate a portion of his or her life insurance amount An interest and expense charge may be deducted from the accelerated payment
Insurance and Employee Benefits | MetLife GEF09-1 FW (The form number above applies to residents of all states except as follows: Form number GEF09-1 FW applies to residents of Oregon; GEF09-1 applies to residents of Louisiana and Montana; GEF09-1 FW applies to residents of North Dakota and Utah) BENEFICIARY DESIGNATION FOR EMPLOYEE INSURANCE I designate the following person(s) as
INSTRUCTIONS STATEMENT OF HEALTH FORM AND THE AUTHORIZATION . . . Note: Additional medical information may be required after MetLife’s initial review of a completed Statement of Health form The additional information requested may be a physical examination, paramedical exam, or an Attending Physician Report Correspondence will be sent within ten days by MetLife or our approved vendor Incomplete forms will be returned to you for completion Some services
[Section 1 - Health] Information - [ For Life AD D Disability . . . 1 Life Insurance may include an Accelerated Benefits Option under which a terminally ill insured can accelerate a portion of his or her life insurance amount An interest and expense charge may be deducted from the accelerated payment
How to Apply for Long Term Disability Conversion Insurance GEF09-1 DEC applies to residents of Connecticut, North Dakota and Utah) In order to complete review of the application, the following must be submitted: This Application, completed and signed; and Employer Questionnaire Form or Health and Insurance Plans Conversion Portability Notice
[Section 1 - Health] Information - [ For Life AD D Disability . . . Based on the enrollment form submitted by the Employee, a Statement of Health form is required to complete the employee’s request for group insurance coverage for you, the Proposed Insured 1 If the Insurance Information Section is not completed, obtain the information before finalizing the form
Statement of Health Forms - myassurantbenefits. com GEF09-1 Yes 10 For residents of all states except CT, please answer the following question: Have you ever been diagnosed or treated by a physician or other health care provider for Acquired Immunodeficiency Syndrome (AIDS), AIDS Related Complex (ARC) or the Human Immunodeficiency Virus (HIV) infection? No