Employee Benefits Forms

Group Life Insurance

Underwritten by UNUM with benefits up to $100,000. This is completely portable with spouse and child coverage and extremely competitive rates.

• Summary of Benefits - Group Term Life Policy
• Group Life Insurance Enrollment Form
• Group Life Change Request Form
• Evidence of Insurability Form
• Beneficiary Designation Form
• Group Life Rates

Voluntary Lifestyle Life

Underwritten by UNUM. Can elect up to five times salary up to a maximum of $500,000. Completely portable or convertible.

• Coverage Highlights for Voluntary Term Life Policy
• Voluntary Life Enrollment Form
• Evidence of Insurability Form
• Voluntary Group Life Rates

Short-Term Disability

Underwritten by UNUM, it provides full maternity benefits. Benefits are a maximum of $1,000 per week for 12 weeks and are available at extremely competitive rates.

• Benefit Summary for Short-Term Disability Coverage
• Short-Term Disability Form for Agencies - Less Than 10 Lives
• Short-Term Disability Form for Agencies - Over 10 Lives
• Evidence of Insurability Form
• Short Term Disability Change Request Form

Long-Term Disability

Underwritten by UNUM with benefits up to $6,000 per month to age 67 (some age restrictions apply). The rates are extremely competitive and the coverage includes additional benefit features such as Disability Plus, Minimum Benefit and a Survivor Benefit.

• Benefit Summary for Long-Term Disability Coverage
• Long-Term Disability Form for Agencies - Less Than 10 Lives
• Long-Term Disability Form for Agencies - Over 10 Lives
• Evidence of Insurability Form
• Long Term Disability Change Request Form

Long-Term Care

Please contact Cathy Hurley at churley@iianc.com or 888-275-8910.

Dental & Vision

Underwritten by Guardian Life Insurance Company, this program gives you the option to enroll in one of two dental plans offered, as well as a separate Vision plan.  Plans can be offered as an employer paid benefit or offered on a voluntary basis.  Our Guardian dental plans give you the choice of going to an in or out-of-network provider, with the Vision plan using the VSP Provider network.  The vision plan provides a $150 allowance on frames and contacts and co-payments for your annual eye exam and materials. Click here to access the Guardian Dental & Vision Enrollment Kit.