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Application for GROUP SHORT TERM DISABILITY INCOME INSURANCE for Members of the National Postal Mail Handlers Union (NPMHU) Issued through the Voluntary Benefits Plan Insurance Trust Complete this form and return to: UNION MEMBER BENEFITS 2025

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The document is an application form for Group Short Term Disability Income Insurance specifically designed for members of the National Postal Mail Handlers Union (NPMHU). It outlines the necessary member information, insurance request details, and a health statement that applicants must complete to apply for coverage under New York Life Insurance Company. The form requires personal details, occupational status, and health history to assess eligibility for disability benefits.

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How to use or fill out Application for GROUP SHORT TERM DISABILITY INCOME INSURANCE for Members of the National Postal Mail Handlers Union (NPMHU) Issued through the Voluntary Benefits Plan Insurance Trust

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Click ‘Get Form’ to open it in the editor.
Begin with SECTION A – MEMBER INFORMATION. Fill in your name, address, and contact details accurately. Ensure you provide your Social Security Number and Date of Birth in the specified format.
Indicate your marital status and occupational status by selecting the appropriate options. If applicable, provide details about any other insurance plans you are currently enrolled in.
Move to SECTION B – INSURANCE REQUESTED. Specify whether you are applying for new or additional coverage and indicate your desired monthly benefit option.
In SECTION C – STATEMENT OF HEALTH, answer all health-related questions truthfully. Initial any changes made to your responses.
Complete the authorization section at the end of the form, ensuring you sign and date it appropriately before submission.

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What is the purpose of a disability income policy?

An individual Disability Income insurance applicant may be required to submit information such as medical history, gross income, occupation, and spouses occupation. This information helps assess the applicants health, determine appropriate coverage, and consider additional sources of income in case of disability.

What is group disability income?

Employers can help protect against that risk by providing group disability income insurance a group insurance product that provides income replacement benefits to an employee should he or she become sick or injured and unable to work.

What does group disability mean?

Group disability plans typically provide a totally disabled covered employee with a benefit of up to 60% of their pre-disability income, to a specified maximum, such as $10,000 a month. It can help to cover personal expenses as well as provide business overhead protection.