RESOURCES

Administration Forms

Forms are always available to conveniently download in PDF format. View and print the forms you need or call (Toll-Free) 866-373-9607 or (Local) 847-283-2551 for copies.

Enrollment Card (TMT Group Insurance Trust)

Enrollment Card (Christian Schools International)

Enrollment Card (ALL other associations)

Special Note: Please have new enrollee(s) answer all questions on pages 1-2. Sign and date the "Agreement and Authorization" page. DO NOT ANSWER ANY OF THE QUESTIONS IN THE "HEALTH QUESTIONNAIRE" section. Review the form for accuracy and completeness. Keep a copy with your insurance records and mail or FAX (847-615-3898) a copy to: Trustmark Affinity Markets, Premium Accounting & Eligibility Department, PO Box 7952, Lake Forest, IL 60045.

If your state is currently NOT available from the drop-down menu, please call (866) 373-9607 to receive a copy of the correct enrollment form.  

Application for Continuation of Coverage

Automatic Payment Withdrawal (APW) Authorization Form

Accelerated Life Benefit Request

Waiver of Premium-Extended Death Benefit

Pre-Enrollment Authorization

Verification of Dependent Eligibility

Verification of Dependent Eligibility Incapacitated

Dependent Student Certification

Evidence of Insurability

Proof of Loss of Limb(s) or Sight Statement

Proof of Death

Request for Change Form

Beneficiary Change Form

Short-Term Disability Claim Form