Policy Changes - Disability Insurance

Choose one of the following:

• Call the Customer Service department at (800) 233-3750 ext. 503.
• Fax, mail or email a written request (please indicate the contract number and whose address you are changing).
• Complete and return the change notification slip attached to your premium billing envelope.

Complete a Contract Change Form: L-5454 and send it to us by fax, mail or email.

This form requires the following information:

• Contract number
• Insured name
• Owner name
• Complete all items in Section 1 on this form (If this request is for reasons other than indicated in this section or because of a court order or adoption, then legal evidence of the name change must be provided with the request.)
• Obtain the required signatures at the bottom of the form (insured, owner if other than insured, beneficiary if irrevocable, and a witness signature)

Complete Ownership/Contingent Ownership Designation Form: L-5535 and send it to us by fax, mail or email.

Please Note:

• When the current contract owner is a business or trust, the form must include the name of the business or trust, and the title of the person signing. The person who signs should not be the person insured or the person who will benefit from the change.
• After we have accepted and recorded the information on your owner designation form, the change will be effective the date the form was signed.
• Changing the ownership of a policy does not change the payor.

Complete Statement of Lost Contract Form: L- 5431 and send it to us by fax, mail or email.