Because you are applying outside of a 60-day open window, medical underwriting is required for the Life, LTD & ADD&D coverage.

Please complete form #3.

Optimum – If you choose to apply for the Optimum level of coverage, complete a Form 2, Statement of Health. The Optimum plan is NOT guaranteed. You may be declined the Optimum plan due to medical condition(s) disclosed in medical history OR be offered the Optimum plan with exclusions on medication categories used to treat pre-existing conditions. During the underwriting process for Optimum, you will be enrolled in the guaranteed option of your choice. Rates will be adjusted if applicable at the time of approval. If you are not approved for the Optimum this will not impact the guaranteed options available to you. 

Stated maximums are per benefit year, unless otherwise specified and apply to each plan member and insured dependent. 

**We have a special offer just for you!**

In addition to the standard $1,000 long term disability coverage, (already included with Supreme), employees under age 35 may be eligible for up to an additional $1,000 of excess long-term disability coverage at no cost! This additional coverage is subject to medical underwriting & restrictions (Form 3 and 4 is required). 

You have the option to increase your Life Insurance and Long-Term Disability as well as purchase additional coverage for a spouse and/or a child(ren). Form 3, 4, 5 and 6 are required.

View Our Fine Print