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1. Review Your Plan DetailsFamiliarize yourself with the details of your plan.2. Important Information About Your EnrollmentPlease read and print the following documents for your records. These are state required documents to assist with long term care insurance decisions. Nothing in this section needs to be returned in order to apply during your initial enrollment, unless it is also specified as a required form for enrollment in your section below.
3. Employee Enrollment
Print out the forms below. Complete, save a copy for your records, and submit these forms to:
Your Employer.
Please note, the Long Term Care Insurance Application (medical questionnaire) can be returned directly to Unum at the address
listed on the form.
Employee Enrollment Form Long Term Care Insurance Application (7040-04-OR) with HIPAA Authorization (6720-03) Acknowledgement of Disclosure of Rating Practices (7604-04) 4. Spouse/Domestic Partner EnrollmentAll spouse/domestic partner coverage is medically underwritten. The Long Term Care Insurance Application must be completed along with the Enrollment Form. To apply for coverage, print and complete these forms, and submit them to: The Employer. Please note, the Long Term Care Insurance Application (medical questionnaire) can be returned directly to Unum at the address listed on the form.Spouse/Domestic Partner Enrollment Form Long Term Care Insurance Application (7040-04-OR) with HIPAA Authorization (6720-03) Domestic Partner Statement Form (1434-97) 5. Family EnrollmentFamily coverage is medically underwritten. The Long Term Care Insurance Application must be completed along with the Enrollment Form. To apply for coverage, print and complete these forms, and submit them to: Group Long Term Care, Unum Life Insurance Company of America, 2211 Congress Street, Portland, ME 04122.Family Enrollment Form Long Term Care Insurance Application (7040-04-OR) with HIPAA Authorization (6720-03) Be sure to read the documents in section two above. Eligible family members who would like to apply for coverage require these additional form(s): 
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