Feb 22, 2012

Applications & Forms 

The following insurance plans are available to active members of AIChE. Please visit the insurance product pages on this website to review the full eligibility requirements of each plan.

Life Insurance Plans

Group Term Life Insurance – Coverage amounts from $10,000 to $1,000,000

Apply Online (available to members under age 60)
Download PDF (available to members under age 70)
Coverage is currently not available for residents of TN.

Group 10-Year Level Term Life Insurance – Coverage amounts from $100,000 to $2,000,000

Apply Online (available to members under age 65)
Download PDF (available to members under age 65)
Coverage is currently not available for residents of TN.

Group 20-Year Level Term Life Insurance – Coverage amounts from $100,000 to $2,000,000

Apply Online (available to members under age 55)
Download PDF (available to members under age 55)
Coverage is currently not available for residents of NC, TN, TX, VT and WA.
 

Group Accidental Death & Dismemberment (AD&D) Insurance

Download PDF (available to members under age 70)
Coverage is currently not available for residents of FL, NC, TN, VT and WA.
 

Supplemental Forms

Declaration of Domestic Partnership Form – Complete this form if you are applying for coverage for a domestic partner. Domestic Partnerships and Civil Unions are determined by state law. Coverage for domestic partner is not available for residents of OR.

Beneficiary Designation Change Form – Complete this form if you would like to change beneficiaries on your existing plan.

 

 Group Disability Income Insurance

Download PDF
Coverage is currently not available for residents of TN.
 

Group Basic and Enhanced Dental Insurance

Download PDF – CA residents
Download PDF – FL residents
Download PDF – MO residents
Download PDF – VA residents
Download PDF – residents of all other states
Coverage is currently not available for residents of TN.
 

Discount Dental Insurance

Download PDF
Coverage is currently not available for residents of TN.
 

Cancer Expense Insurance

Download PDF – KS residents
Download PDF – WI residents
Download PDF – residents of all other states
Coverage is currently not available for residents of CT, GA, ID, LA, MA, ME, MN, NH, NJ, NY, OR, SD, TN, UT, VT, WA, WI, WY.