| Insurance Forms |
| Disability Insurance |
| Long-Term Disability (LTD) Change Form Use this form to make changes to preexisting LTD coverage through Nazarene Benefits USA. |
| Long-Term Disability Insurance Application This application is for enrolling in the Nazarene Long-Term Disability (LTD) Insurance Plan. |
| Life Insurance |
| Accidental Death and Dismemberment Insurance Application This application is for enrolling in the Accidental Death and Dismemberment (AD&D) Insurance Plan. |
| Beneficiary Change/Designation Form This form is used to designate or change beneficiaries for the Active Survivor Benefit, Retiree Survivor Benefit, Supplemental Group Term, District Life, Missionary Life and Accidental Death & Dismemberment insurance plans. |
| Evidence of Insurability This form is used when applying for one of the insurance plans outside of an open enrollment period, more than 90 days past eligibility or if enrolling for an amount above the guaranteed issue amounts. Contact us at 888-888-4656 or benefits@nazarene.org. |
| Active Survivor Benefit/Retiree Survivor Benefit Application This application is for enrolling in the Active Survivor Benefit or Retiree Survivor Benefit. |
| Supplemental Group Term Life Insurance Application This application is for enrolling in the Nazarene Supplemental Group Term Life Insurance Plan. |
Insurance Forms and Documents
Top