Policy Change Forms

(INCLUDES POLICY CONVERSIONS AND REINSTATEMENTS)

PLEASE NOTE: The Health Insurance Portability and Accountability Act (HIPAA) Authorization form must be submitted with your policy change/reinstatement request.

For Virginia, submit HIPAA Authorization form L-3100VA.
All other states, submit HIPAA Authorization form L-3100.

Policy Conversions - click on the name of the state of your current residence to obtain the proper form.
For All Other Policy Changes - click on the name of the state that the policy was issued in to obtain the proper form.

Statement of Health Forms

All other states - click here