Get Extended Employee Application - Assurant Employee Benefits

Completing the Extended Employee Application is an important step in securing your employee benefits with Assurant. This guide will provide you with clear, step-by-step instructions to help you fill out the application accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the application document and begin the filling process.
2. Fill in the required fields at the top of the application, including your Group policy/participant number, Cert. number, Account number, Employer name, and Employment location with phone number. Make sure all entries are accurate, as they are essential for processing your application.
3. Provide your personal information, including your full name, employment status, job title, date of birth, and Social Security number. Indicate your employment dates and state of residence as well.
4. Answer the question regarding the marital status and whether you have children, followed by providing your earnings information on an hourly, weekly, monthly, or yearly basis.
5. Specify your home address and phone number, and indicate your employment status (active, retired, on leave, etc.). Ensure the status section is completed, as it determines your coverage eligibility.
6. Review the coverage options available under your employer’s plan. Mark an 'X' in the boxes for Basic Life, Optional Additional Life, and other benefits you are applying for.
7. If applicable, answer the health questions on page 2. This includes providing details about weight changes, medical history, and any medications currently being taken.
8. Complete the beneficiaries section by providing names, relationships, and additional information for each beneficiary, ensuring all required fields are filled in.
9. Read and acknowledge the Important Notice and Authorization to Release Information sections. Sign and date at the bottom of the form. If you are applying for spousal coverage, they will also need to sign.
10. Once all sections are fully completed and verified, you can save the changes, download the form for your records, print it for submission, or share it as required.

Complete your Extended Employee Application online today to secure your employee benefits.