Open Enrollment for New Independent Business Owners
Underwritten by Metropolitan Life Insurance Company New York, NY
Listed below are easy to follow step-by-step instructions to complete and submit the enrollment form for the Voluntary Term Life Insurance Policy and Accidental Death & Dismemberment Insurance Rider.
To take advantage of this open enrollment offer, 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 issued 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 term life (162250-1-G) policy,
- Thoroughly read the details of the Group Term Life Insurance policy, including the coverage highlights, the limitations and exclusions located under the Eligibility link on this website. Some industries limit the guaranteed issue amount you may enroll for under this Group Term Life insurance plan
- Please complete the entire enrollment form titled Life Insurance Guaranteed Issue Enrollment Form.
- Include your non-IBO spouse and dependent child(ren) elections on the same form. If your spouse is also an IBO, your spouse should complete their own form.
- The fields are "fillable", you should be able to type on the form.
- You are the beneficiary for you non-IBO spouse and/or dependent child(ren).
- 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 and Authorization page 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.
If you (or your spouse if enrolling) are age 65 or older on the date insurance becomes effective, the amount of life and AD&D insurance will be reduced 50 percent of the original amount you are requesting.
Voluntary Term Life Insurance and 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, 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.
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