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.
- Christian Schools International (+50 lives)
- Christian Schools International Illinois application (1-50 lives)
- Illinois application (1-50 lives)
- Nebraska Uniform - Optional
- TMT Group Insurance Trust (+50 lives)
- TMT Group Insurance Trust Illinois application (1-50 lives)
- Virginia universal application - Optional
- Wisconsin uniform - Mandatory for new business
-
Special Note: Please have enrollee(s) answer all questions. Sign and date the "Agreement and Authorization" page. ANSWER ALL 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
Dependent Student Verification
Verification of Dependent Eligibility Incapacitated