Voluntary Group Term Life 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 Term Life Insurance Policy and Accidental Death & Dismemberment Insurance Rider (Voluntary Term Life/AD&D).
- Thoroughly read the details of the Voluntary Group Term Life insurance policy, including the coverage provided, limitations and exclusions, located under the Eligibility link on this website. Some industries limit the amount of group term life coverage you are eligible to elect.
- Choose the enrollment form according to your age, amount of coverage and if you are in Class 1 or Class 2 (non-preferred industries). The forms are “fillable”, you should be able to type on the form:
- Class 1: If you are not engaged in a non-preferred industry, choose your form from the following chart:
Age |
Coverage Amount in Increments of $25,000 |
Enrollment & Authorization Form - Class 1 |
Under 50 |
$25,000 - $250,000
$275,000 - $1,000,000
|
Simplified Issue Form
SOH Form
|
50 - 59 |
$25,000 - $150,000
$175,000 - $1,000,000
|
Simplified Issue Form
SOH Form
|
60 - 69 |
$25,000 - $1,000,000 |
SOH Form |
- Class 2: If you are engaged in a non-preferred industry, choose your form from the following chart:
Age |
Coverage Amount - $25,000 |
Enrollment & Authorization Form - Class 2 |
Under 69 |
$25,000 |
Simplified Issue 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.
- You are the beneficiary for your non-IBO spouse and dependent child(ren)
- Once the entire form is complete, print it as you will need to provide a wet signature. In ink, please sign the Declarations and Signature page AND the Authorization page.
- Mail completed Enrollment form and the Authorization page 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 have been notified in writing that this enrollment has been approved and you have paid your initial premium as billed.
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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