Voluntary Accidental Death & Dismemberment Insurance
Underwritten by Metropolitan Life Insurance Company New York, NY
How To Enroll
Listed below are easy to follow step-by-step instructions to complete and submit the enrollment form for the Voluntary Accidental Death & Dismemberment Insurance (AD&D).
- Thoroughly read the details of the Voluntary Accidental Death and Dismemberment Insurance policy, including the coverage provided, limitations, and exclusions, located under the Eligibility link on this website.
- Please complete the entire enrollment form titled Accidental Death & Dismemberment Enrollment Form
- IBO Member Only Plan: if your spouse is also an IBO, your spouse may also enroll for the IBO Member Only plan and should complete their own form.
- IBO Family Plan: your spouse is automatically covered. An IBO may not be covered more than once under this AD&D plan.
- You are the beneficiary for your spouse and/or dependent child(ren).
- The fields are "fillable", you should be able to type on the form.
- Once the entire form is complete, print it as you will need to provide a wet signature. Please sign the form (on page 3) in ink.
- Mail completed enrollment form to:
USI Affinity
14 Cliffwood Ave.
Suite 310
Matawan, NJ 07747
Questions
If you have any questions or need assistance in completing your enrollment form, please contact USI Affinity at 1-800-254-2327 or email us with your questions.
Please do not submit payment with your enrollment form. Providing your enrollment is approved, you will be billed. Do not cancel any other coverage until you've been notified (in writing) that your enrollment has been approved and you have paid your initial premium as billed. Your effective date will be the first of the month following approval of your enrollment form providing initial payment has been paid.
Note: Incomplete enrollment forms will be returned to you and will delay the process.
Voluntary Accidental Death and Dismemberment insurance underwritten by Metropolitan Life Insurance Company New York, NY. Group Policy Form: 162250-1-G
Like most insurance policies, MetLife policies contain certain exclusions, waiting periods, reductions, limitations and terms for keeping them inforce. All policies and riders may not be available in all states or at all issue ages. Please contact your plan administrator at 1-800-254-2327 for details.
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