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1. Review Your Plan Details

Familiarize yourself with the details of your plan.

2. Important Information About Your Enrollment

Please 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. Retiree and Family Enrollment

Retiree and Family 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.

Retiree and Family Enrollment Form
Choose your plan options and submit the form.

Long Term Care Insurance Application (7040-04-OR) with HIPAA Authorization (6720-03)
(Evidence of Insurability - Medical Questionnaire)
Required to be returned to insurer.

Be sure to read the documents in section two above.

Eligible retiree and family who would like to apply for coverage require these additional form(s):
LTC Personal Worksheet (AE-7009)
3rd Party Notice of Prem Lapse (7606-04)

Questions? Contact Unum toll-free at 1-800-227-4165 for more information.

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