Applications & Forms
Group Term Life Insurance Plan
Group First-To-Die Term Life Plan
Group 10-Year Level Premium Term Life
Group High-Limit Accidental Death and Dismemberment Plan
Group Disability Income Insurance Plan
Dental Insurance Plan
To download a paper application, click here. Online enrollment is not available for this Plan.
Group In-Hospital Insurance Plan
1. Check the Insurance Plans page to locate the Plan of your choice. You’ll find a description of Plan benefits and premium costs. Please refer to this Plan description as you complete your Application. Please complete it fully, being sure that it is signed and dated.
2. For the Term Life, First-to-Die Life, 10-Year Level Term Life, Disability, send no money now. You will be billed once coverage is approved.
For all other Plans, please make out your premium check for the total amount due. If you are requesting coverage for your spouse or children, you'll need to add their premium to yours. Make your check payable to: GeoCare Benefits Insurance Program.
3. Mail your signed, completed application with your premium check, if needed now, to:
SPE Insurance Program
P.O. Box 9159
Phoenix, AZ 85068-9159
How You Can Help Make the Application Process Go Smoothly
When you fill out your application, make sure your answers are complete and detailed. Answer all questions, so processing of your application won't be delayed.
Complete medical information should include the name of physician(s) or hospital(s), street address (and suite or room number), city, state and zip code. Also include a brief description of the nature of an illness or injury, symptoms, treatment and results.
The insurance company underwriting your application relies on your answers and statements. Misstatements or failures to report information on your application may be used as the basis for denying or reducing claim benefits, or even invalidating your insurance.
Health/Medical (MSA Qualified Health)
Important Notice for In-Hospital and Health/Medical claim forms
Change of Beneficiary Forms
Change of Beneficiary Form Guidelines
- Please read the instructions carefully before completing.
- Please specify your beneficiary or beneficiaries.
- Be sure to include their relationship to you.
- Please include a Social Security number of beneficiary.
- Send the completed form to:
- SPE Insurance Program
PO Box 189, Santa Barbara, CA 93102-0189
- SPE Insurance Program
Popular Beneficiary Designations:
A married woman should be designated by her first name, middle initial and last name. For example, Mary J. Smith, not Mrs. Thomas Smith.
If your beneficiary is not related to you by blood or marriage, "business associate", "partner", or other economic relationship should be inserted; otherwise "non-relative".
|1. One beneficiary only:||Mary J. Smith, wife|
|2. Two or more beneficiaries, equal amounts:||William S. Smith, father|
Alice C. Smith, sister and Richard B. Smith, brother, equally or to the survivors equally, or to the survivor.
|3. Unequal amounts:||50% to Mary J. Smith, wife and 25% each to Alice C. Smith, sister and Richard B. Smith, brother, the share of any deceased beneficiary to be paid in equal shares to the survivors, or to the survivor.|
|4. Primary and contingent beneficiary:||Mary J. Smith, wife, if living; otherwise the children born of the marriage of the insured to Mary J. Smith equally, or equally to the survivors, or to the survivor.|
|5. Trustee beneficiary:||The Trust Company of Smith, Illinois as trustee under a Trust Instrument dated December 29, 1987.|
Have a Question or Need Additional Information?
If you have a question, need more information, or you need to file a claim, please don't hesitate to contact your SPE Customer Service Representative.