Insurance Forms and Documents

Here are the most common forms associated with our insurance plans. If you have other questions, please contact us at 888-888-4656 or benefits@nazarene.org.

Note, for best results, Adobe Acrobat Reader is recommended when filling in the applications and forms. Be sure to download the document to your computer before starting to complete the pdf form, otherwise, you may lose your edits.

Insurance Forms
Disability Insurance
Long-Term Disability (LTD) Change Form
Use this form to make changes to preexisting LTD coverage through Nazarene Benefits USA.
Long-Term Disability Insurance Application
This application is for enrolling in the Nazarene Long-Term Disability (LTD) Insurance Plan.
Life Insurance
Accidental Death and Dismemberment Insurance Application
This application is for enrolling in the Accidental Death and Dismemberment (AD&D) Insurance Plan.
Beneficiary Change/Designation Form
This form is used to designate or change beneficiaries for the Active Survivor Benefit, Retiree Survivor Benefit, Supplemental Group Term, District Life, Missionary Life and Accidental Death & Dismemberment insurance plans.
Supplemental Group Term Life Insurance Application
This application is for enrolling in the Nazarene Supplemental Group Term Life Insurance Plan.


Written by Staff
Published: 01/13/2020