Request a Call from the Policy Continuation Team

Check all that apply: *

I am retiring and want to know my options.

I am leaving my employer and want to keep my benefits.

My employer is no longer offering payroll deduction for my coverage.

Set up EFT for premium payment.

appt instructions

Tip! The fastest way to request continuation of your coverage is through your online account. Log in now to complete the request form.
You may also schedule an appointment with the Policy Continuation team.

Contact Information

First Name *

Last Name *

Employer Name *

Email *

Phone *

Customer Number

Additional Information

Details or Comments *

Do Not Call Disclaimer

By providing my phone number or email address, I agree to allow American Fidelity Assurance Company to contact me regardless of my status on any Do-Not-Contact list. Contact Terms and Conditions

Solutions for Employers

Resource Library

An Employer's Guide to a Successful Enrollment

Request a Call from the Policy Continuation Team