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1. Review Your Plan Details
Familiarize yourself with the details of your plan.2. Important Information About Your Enrollment
Read and print for your records. These are for information only. Nothing in this section needs to be completed and sent into Unum.3. Employee Enrollment
Employee Enrollment Form
Choose your plan options and submit the form.
Long Term Care Insurance Application (7045-04)
(medical questionnaire)
If you enroll after the Guarantee Issue enrollment period, or choose benefits over the Guarantee Issue limits, you will be required to fill out Unum's Long Term Care Insurance Application (medical questionnaire).
Acknowledgement of Disclosure of Rating Practices (7604-04)
REQUIRED to be returned to insurer by all except certholders covered under 100% employer funded policy with no buy-ups.
4. Spouse Enrollment
All spouse coverage is medically underwritten. The Long Term Care Insurance Application must be completed along with the Enrollment Form. To apply for coverage, print and complete these forms, and mail to: The Employer. Please note, the Long Term Care Insurance Application (medical questionnaire) can be returned directly to Unum at the address listed on the form.Spouse Enrollment Form
Choose your plan options and submit the form.
Long Term Care Insurance Application (7045-04)
Required to be returned to insurer.
Acknowledgement of Disclosure of Rating Practices (7604-04)
REQUIRED to be returned to insurer by all except certholders covered under 100% employer funded policy with no buy-ups.
5. Family Enrollment
Family coverage is medically underwritten. The Long Term Care Insurance Application must be completed along with the Enrollment Form. To apply for coverage, print and complete these forms, and mail to: Group Long Term Care, Unum Life Insurance Company of America, 2211 Congress Street, Portland, ME 04122.Family Enrollment Form
Choose your plan options and submit the form.
Long Term Care Insurance Application (7045-04)
Required to be returned to insurer.
Acknowledgement of Disclosure of Rating Practices (7604-04)
REQUIRED to be returned to insurer by all.
Be sure to read the documents in section two above.
Eligible family members who would like to apply for coverage require these additional form(s):
Personal Worksheet (AE-7009-WA)
3rd Party Notice of Prem Lapse (7606-04)
