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Metropolitan Life Insurance Company, New York, NY 10166Office #191ENROLLMENT FORM FOR NEW YORK RESIDENTS ONLY GROUP CUSTOMER INFORMATION (To be Completed by the Recordkeeper) Name of Group Customer/Employer

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How to fill out critical illness retiree enrollment

01

Obtain the critical illness retiree enrollment form from the HR department or online portal.

02

Fill in your personal information such as name, address, social security number, and date of birth.

03

Provide details of your current health insurance coverage, if applicable.

04

Select the coverage options you want for critical illness benefits.

05

Sign and date the form, and submit it according to the instructions provided.

Who needs critical illness retiree enrollment?

01

Retirees who want to ensure they have financial protection in case of a critical illness diagnosis.

02

Retirees who do not have sufficient savings to cover medical expenses related to a critical illness.

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What is critical illness retiree enrollment?

Critical illness retiree enrollment is a process where retired individuals sign up for coverage specifically for critical illnesses.

Who is required to file critical illness retiree enrollment?

Retirees who are interested in obtaining coverage for critical illnesses are required to file critical illness retiree enrollment.

How to fill out critical illness retiree enrollment?

Critical illness retiree enrollment can be filled out online or through paper forms provided by the insurance company.

What is the purpose of critical illness retiree enrollment?

The purpose of critical illness retiree enrollment is to provide retired individuals with coverage and financial protection in case they are diagnosed with a critical illness.

What information must be reported on critical illness retiree enrollment?

Critical illness retiree enrollment typically requires personal information, health history, and selection of coverage options.

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