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You can apply for our plans in one of the following ways:
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Option 1. Apply Online Now.
Submit your entire application online with no paperwork.
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Option 2. Download & Print Application Now.
You can download the application, print it out, and mail or fax it to our office. |
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Use this form to apply for 3080, 4080, 4070, 4070 Value, HSA, Dental and Vision plans as well as Maternity Services and Mental Health riders.
Consumers Life Insurance Company
Business Distribution Solutions
2720 Dupont Commerce Court
Suite 170
Fort Wayne, IN 46825
Toll free: 800/338-5915
Fax: 800/341-1854 |
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Option 3. Request An Application.
We can send you an application by mail, email, or by fax. Just fill out the form below. |
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Option 4. Would you rather talk to us?
Just call us at 800/338-5915 and we'll help you apply step-by-step. | |
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Additional instructions: |
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Call 800/338-5915 if you need help or to learn more. |
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Once you have downloaded and printed out the form write clearly using a blue or black ballpoint pen. |
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After carefully reading each section and answering all questions, be sure to sign and date the application. All applications will be considered invalid 60 days after the signature date. |
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What happens next: |
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Once your application is received, it will be reviewed to ensure that all questions have been completed and answered. |
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Your application will be sent to Consumers Life's Underwriting department for further review. |
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Typically within five to seven days, we will notify you of your acceptance (including your actual monthly premium) or inform you if you have been denied coverage. At that time, if you accept the approved premium rates, an invoice for the first month of premium will be mailed to you. | |
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Do not cancel any current health insurance coverage until you receive an approval letter and insurance policy, also known as insurance contract or certificate, from Consumers Life. Make sure you understand and agree with the term of the policy. Pay special attention to the effective date, premium amount, benefits, limitations, exclusions, and riders.
The rates quoted are estimates only, and are subject to change based on your medical history, the underwriting practices of Consumers Life, the optional benefits you selected, if any, and other relevant factors. Consumers Life reserves the right to change the terms of the policy under proper notification. |
