Request a Call from the Policy Continuation Team

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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.

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 Your Customer Number can be found on a policy document or certificate.

Additional Information

Details or Comments * Please do not enter any sensitive personal information.

+ By submitting this form, I consent to being contacted, including by phone or email, regardless of my status on any Do-Not-Call or Do-Not-Email lists.