Voluntary Long-Term Disability Insurance

Underwritten by Metropolitan Life Insurance Company New York, NY

Open Enrollment for New Independent Business Owners

Listed below are easy to follow step-by-step instructions to complete and submit the enrollment form for Voluntary Long-Term Disability Insurance.

To take advantage of this open enrollment, you must enroll within 60 days of becoming an IBO. If you miss this open enrollment opportunity or wish to apply for more than the guaranteed issue amount, you will be required to provide evidence of insurability and may contact our office at 800-254-2327 for details. This open enrollment offer is available to IBOs who are not currently insured under the IBOBA Group Long-Term Disability (162250-1-G) policy .

1. Thoroughly read the details of the Group Long-Term Disability insurance plan, including the coverage highlights, the limitations and exclusions located under the Eligibility link on this website. Some industries limit the guarantee issue amount you may enroll for under this Group Long-Term Disability insurance plan
2. Please complete the entire enrollment form titled Long Term Disability Insurance Guarantee Issue Enrollment Form.
   • If your spouse is also an IBO meeting all the eligibility requirements, your spouse should complete their own form.
   • The fields are "fillable", you should be able to type on the form.
3. Once the entire form is complete, print it as you will need to provide a wet signature. Please sign the form (on page 2) in ink.
4. Mail completed enrollment form to:
   USI Affinity
   14 Cliffwood Ave.
   Suite 310
   Matawan, NJ 07747

*Some Non-Preferred Industries limit the Benefit Amount you are eligible to elect.

Enrollment Form (Class 1=IBOs not engaged in Non-Preferred Industries)
Enrollment Form (Class 2=IBOs engaged in Non-Preferred Industries)
Eligibility
View Rates

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 have been notified in writing that this enrollment has been approved and you have paid your initial premium as billed.

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.

Disability 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, at all issue ages and to all occupational classes. Coverage may be subject to underwriting approval. Please contact your plan administrator at 1-800-254-2327 for details.

L0316458797