Contact Policy Continuation

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.

First Name *

Last Name *

Employer Name

Employer State

Email *

Phone *

Best time of day to reach you in Central Standard Time (CST) (Select all that apply) *

Best day of the week to reach you? (Select all that apply) *

Monday

Tuesday

Wednesday

Thursday

Friday

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

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

Request a Call from the Policy Continuation Team