Death Claims

Remember to complete any applicable Administrator or Employer section(s) before distributing forms to beneficiaries.

Frequently Asked Questions for Death Claims

To submit a claim, you need to distribute the following forms to EACH beneficiary:

  • Claim form
  • Voya™ Personal Transition Account Supplemental Contract (not applicable for beneficiaries residing in Alaska, Illinois, Kansas, North Carolina or Nevada)
  • If a Trust is named as the beneficiary, the Trust Verification form must be completed by the trustee of the trust.
Forms for Association Group Term Life, PAI and Individual YRT Form Number

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in Arkansas, Indiana, Kentucky, Louisiana, North Dakota, or Rhode Island

159972 (rev 9/01/14)
159729 (rev 9/01/14)

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in California, Florida or Minnesota. ALSO USE IF INSURED RESIDED IN MINNESOTA AT TIME OF DEATH OR FOR POLICIES ISSUED OR SITUSED IN MINNESOTA.

159818 (rev 9/01/14)
159729 (rev 9/01/14)

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in New York. ALSO USE FOR POLICIES ISSUED OR SITUSED IN NEW YORK.

126266 (rev 9/01/14)
159729 (rev 9/01/14)

Claim form for beneficiaries residing in Alaska, Illinois, Kansas, North Carolina, or Nevada

159817 (rev 9/01/14)

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in all other states

115701 (rev 9/01/14)
159729 (rev 9/01/14)

Trust Verification Form Number

Trust Verification

142020 (rev 9/01/14)

Voya™ Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya™ family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.