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Claims Forms

For your convenience, we now have available a Claims Center where you can find claims forms or begin filing a claim.

Administration Forms

The forms provided here are standard Administration forms, other than Claims. Any Enrollment or Application forms must be obtained through your Account Manager.

Change Request Forms+

The forms below allow you the make changes to an insured’s policy.

  • Use the Request for Change form to process changes such as name or address, and coverage reductions or terminations.
  • Use the Amendment to Original Application if a person needs to switch his/her status to “non-tobacco user” for the purpose of premium rates. This is not available on all plans.
Beneficiary Designation+

The completed form must be sent to the insurer for approval (along with copies of all enrollment forms or applications, beneficiary changes and assignments) in any of the following situations:

  • If the designation differs from the examples on page 2 of the form,
  • If the coverage has been assigned,
  • If the previous beneficiary was irrevocable,
  • If coverage is under an individual policy, or
  • If the insurer maintains all the beneficiary designation records for your plan.
Assignment of Life Insurance+

If the current owner of life insurance wants to assign ownership of coverage, then the current owner and the new owner must complete and sign this form. Check the policy or certificate to determine what types of assignments are allowed.

The completed form must be sent to the insurer for approval, along with copies of all enrollment forms or applications, beneficiary designations and past assignments.

Statement of Intent+

If group life insurance was assigned under a prior group policy, then in order to continue the assignment under the new Group Policy the insured person and the owner must complete and sign a Statement of Intent form.

The completed form must be sent to the insurer for approval, along with copies of all enrollment forms or applications, beneficiary designations and the prior absolute assignment.

Life Conversion+

Use this form when insured and/or dependent life coverage becomes eligible for conversion.

  • Check the group policy or certificate for the Conditions for Conversion.
  • Remember to complete the Employer or Administrator section(s) before distributing the form to the insured person(s).
  • If ownership of coverage is assigned, the form must be distributed to the owner instead of to the insured person.
  • NOTE: There are time limits that pertain to your distribution of this form and the recipient's return of the completed form to the insurance company. See the policy or certificate for details.
  • NOTE: This form must be provided each time life coverage becomes eligible for conversion, even if the insured person may also be eligible for other benefits under the group policy.
  • NOTE: For insureds covered under a group policy issued in Rhode Island, no other notice may be included with the conversion request form and conversion brochure.

Insurance products in the U.S. are provided by ReliaStar Life Insurance Company (Home and Administration Office: Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Home Office: Woodbury, NY. Administration Office: Minneapolis, MN). 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.