Claim Filing Instructions This Statement of Accident includes the forms required to apply for Voluntary Accident benefits. Please read this instructions carefully before submitting to LifeMap.

If you have more than on LifeMap insurance policy, we will apply this authorization to all policies. I AUTHORIZE LifeMap Assurance Company (LifeMap) to disclose the following of information: …

Assignment of Life Insurance Proceeds I, _____________________, being entitled to receive benefits under Policy Number _____________ issued by LifeMap Beneficiary Name …

LifeMap ofers FMLA, ADA and other types of leave administration as a buy-up option through FMLASource. Sign up and you’ll enjoy: • Lower administrative costs and improved eficiency • …

• I understand that LifeMap will release information to my employer necessary for return to work and accommodation discussions, and when performing administration for my employer’s self …

This means legal expenses for the beneficiary and delay in the payment of the insurance. Please take this into consideration when naming your beneficiary. If you have any questions, please …

APPRECIATION FOR EXCELLENCE ed and appointed with LifeMap. They’re designed to provide compelling inc ntives for your sales efforts. In many instances we also offer higher …

You may enroll for Child Only coverage. If you are enrolling children only, a separate application must be completed and submitted for each child. If you have any questions, please call toll …

Dependent Eligibility Requirement Dependents must be a Legal spouse and/or child(ren) up to age 26 of the covered employee to be eligible for coverage. LifeMap Network

Long Term Disability (LTD) & Life Waiver: (800) 254-0085 or [email protected] LTD and Life Waiver claims address: LifeMap Claims 300 Southborough Drive, Suite 200 South …