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NEA Life/AD D INSURANCE PLANS NON-SMOKER DECLARATION If you wish to request non-smoker rates for yourself or your spouse for the plan indicated below please complete this form and either return it to the address listed below or fax it to 515-365-1520 NEA Insurance Operations P. O. Box 9389 Des Moines IA 50306-9389 Please refer to your last premium notice or your Schedule of Benefits for your certificate number. All changes will be effective the first of the month following the receipt of your request. Please print all information in blue or black ink Certificate Number 8 0 2 - Plan Name Member s Name FIRST MI LAST Spouse s Name if insured Address City State Zip Daytime Phone Number - - Smoking Status During the past 24 months have you used tobacco or nicotine in any form Member Yes No Spouse Spouse must sign below in order to request the non-smoker rate. By signing below I declare the information provided is true and complete. We cannot process your request without your signature. O. B....

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You automatically get life insurance protection. For the first 12 months of membership, eligible NEW members are provided $15,000 of term life insurance, at no cost.

Trusted life insurance protection for new NEA members and their families. Questions? Call 1-855-632-5433. Monday-Friday 8 a.m. – 8 p.m. ET and Saturday 9 a.m. – 1 p.m. ET.

The CTA-endorsed Life insurance Plan from The Standard is designed to supplement your existing Life insurance or help you start new coverage. Making sure you have enough Life insurance during your working years is a critical part of protecting your loved ones.

NEA® Accidental Death & Dismemberment Insurance Plan Accidental Death & Dismemberment insurance, issued by The Prudential Insurance Company of America, helps protect you and your loved ones in the event of a major accident. Coverage is guaranteed, and no medical exams are needed.

What Is Group Term Life Insurance? Group term life insurance is a type of term insurance in which one contract is issued to cover multiple people. The most common group is a company where the contract is issued to the employer who then offers coverage as a benefit to employees.

Is NEA a good company to work for? NEA has an overall rating of 4.0 out of 5, based on over 27 reviews left anonymously by employees. 68% of employees would recommend working at NEA to a friend and 73% have a positive outlook for the business. This rating has improved by 4% over the last 12 months.

For over 50 years, the NEA Members Insurance Trust has been creating exclusive, economical life insurance products for NEA members. Our goal is to offer you quality insurance products, superior service, broad accessibility and competitive pricing thanks to the buying power of over 3 million members.

I declare that: I have not smoked tobacco or any other substances, and/or used smoking alternatives, for example: e-cigarettes, vaping, nicotine gum or patches, within the previous 12 months and I have no intention of restarting.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232