Coverage Selection

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After reviewing the benefits chart, features and provisions section for more information (including costs, exclusions, limitations, reduction in benefits and terms of coverage) on these plan(s)
	New or increased coverage for yourself Select this option if you would like to apply for the NAIFA Disability plan. NAIFA members who are under age 60 and actively at work 30 or more hours per week are eligible for this plan. Did you become a NAIFA member in the last 30 days?
	New or increased coverage for you and your spouse Select this option if you and your spouse would like to apply for the NAIFA Disability plan. NAIFA members and their spouse are eligible for the NAIFA Disability plan regardless of their occupation, if they are under age 60 and actively at work 30 or more hours per week.
	Add your spouse to your current coverage Select this option if you are a current subscriber of the NAIFA Disability plan and would like to add your spouse to your policy. Spouses are eligible for the NAIFA Disability plan regardless of their occupation, if they are under age 60 and actively at work 30 or more hours per week.
	All other requests Select this option if you and/or your spouse would like to change your contact information, downgrade your plan benefits, terminate coverage for yourself and/or your spouse and/or any other requests.
* This policy is guaranteed issue but is subject to a Pre-existing Conditions Limitation. Please see the Features & Provisions for details.

For state CA

For state NY

For other states:

AK, AL, AR, AZ, CA, CO, CT, DE, GA, HI, IA, IL, IN, KS, KY, MA, MI, MN, MS, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, PA, RI, SC, TN, UT, VA, WI, WV, WY

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