Group Term Life Insurance Application

  1. Member Info
  2. Coverage
  3. Health Info
  4. Beneficiaries
  5. Payment Options
  6. Preview

Welcome!

Help protect you and your family by applying for GEBA’s Group Term Life Insurance coverage. Before you begin to fill out the application, we recommend that you have the following information listed in the checklist ready.

If preferred, download and complete the Group Term Life Application to return via fax, mail or email.

Fax: (410) 846-6420 Email: geba@geba.com Mail: GEBA, 1362 Mellon Road, #100, Hanover, MD 21076
New York Life logo

Group Term Life Insurance is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010. View New York Life’s Privacy Notice.

  1. Member Info
  2. Coverage
  3. Health Info
  4. Beneficiaries
  5. Payment Options
  6. Preview

Checklist

  • Your medical records accessible for answering the health-related questions
  • Your spouse’s/partner’s medical records accessible for answering the health-related questions if applying for coverage is needed
  • Physician’s address and phone number for health-related questions
  • Bank account information for payment method

Estimated time to complete: 30 minutes

You will be required to complete the entire application once you start since for security purposes we do not save the application for future access.

Get Started

New York Life logo

Group Term Life Insurance is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010. View New York Life’s Privacy Notice.