Applications

Group Term Life Insurance Coverage

To enroll online, click here. To download a paper application, click here.

Group First-To-Die Term Life Coverage

To enroll online, click here. To download a paper application, click here.

Group 10-Year Level Term Life

To enroll online, click here. To download a paper application, click here.

Group High-Limit Accidental Death and Dismemberment Coverage

To enroll online, click here. To download a paper application, click here.

Group Disability Income Insurance

To apply online, click here. To download a paper application, click here.

Dental Insurance Coverage

To download a paper application, click here. Online enrollment is not available for this Coverage.

Cancer Care Insurance Coverage

To download a paper application, click here. Online enrollment is not available for this Coverage.

1. Check the Insurance Coverages page to locate the Coverage of your choice. You’ll find a description of Coverage benefits and premium costs. Please refer to this Coverage description as you complete your Application. Please complete it fully, being sure that it is signed and dated.

2. For the Term Life, First-to-Die Life, 10-Year Level Term Life, Disability, send no money now. You will be billed once coverage is approved.

For all other Coverages, please make out your premium check for the total amount due. If you are requesting coverage for your spouse or children, you'll need to add their premium to yours. Make your check payable to: GeoCare Benefits Insurance Program.

3. Mail your signed, completed application with your premium check, if needed now, to:

SPE Insurance Program
P.O. Box 9159
Phoenix, AZ 85068-9159

How You Can Help Make the Application Process Go Smoothly

When you fill out your application, make sure your answers are complete and detailed. Answer all questions, so processing of your application won't be delayed.

Complete medical information should include the name of physician(s) or hospital(s), street address (and suite or room number), city, state and zip code. Also include a brief description of the nature of an illness or injury, symptoms, treatment and results.

The insurance company underwriting your application relies on your answers and statements. Misstatements or failures to report information on your application may be used as the basis for denying or reducing claim benefits, or even invalidating your insurance.

Dental
In-Hospital
Health/Medical (MSA Qualified Health)
Important Notice for In-Hospital and Health/Medical claim forms

Term Life
Joint First to Die Term Life
10-Year Level Term Life
High-Limit Accidental Death and Dismemberment

Change of Beneficiary Form Guidelines

1. Please read the instructions carefully before completing.
2. Please specify your beneficiary or beneficiaries.
3. Be sure to include their relationship to you.
4. Please include a Social Security number of beneficiary.
5. Send the completed form to:
   • SPE Insurance Program
     PO Box 189, Santa Barbara, CA 93102-0189

Popular Beneficiary Designations:

A married woman should be designated by her first name, middle initial and last name. For example, Mary J. Smith, not Mrs. Thomas Smith.

If your beneficiary is not related to you by blood or marriage, "business associate", "partner", or other economic relationship should be inserted; otherwise "non-relative".

1. One beneficiary only:	Mary J. Smith, wife
2. Two or more beneficiaries, equal amounts:	William S. Smith, father Alice C. Smith, sister and Richard B. Smith, brother, equally or to the survivors equally, or to the survivor.
3. Unequal amounts:	50% to Mary J. Smith, wife and 25% each to Alice C. Smith, sister and Richard B. Smith, brother, the share of any deceased beneficiary to be paid in equal shares to the survivors, or to the survivor.
4. Primary and contingent beneficiary:	Mary J. Smith, wife, if living; otherwise the children born of the marriage of the insured to Mary J. Smith equally, or equally to the survivors, or to the survivor.
5. Trustee beneficiary:	The Trust Company of Smith, Illinois as trustee under a Trust Instrument dated December 29, 1987.