Service Forms

For establishing the privilege to make changes to your contract via telephone. With this option you can submit an exchange between funds and change your future allocations.

Use this form to establish the Scheduled Systematic Withdrawal (SSW) from your account, as required by the Internal
Revenue Service for beneficiary accounts.

Use this form to change employee status. Complete this form and enclose it with your payroll for any new employees not listed or terminated since the last contribution list.

Use this form to establish a new Healthcare Reimbursement Account. Provide your employer a copy of this form.

Use this form to authorize Security Benefit Corporation, or its subsidiaries (“Security Benefit”), to initiate periodic electronic transactions to/from the Employer’s bank account as indicated on this form, to reflect the Employer’s Plan cont

Use this form for each employee group adopting the Security Benefit Group Healthcare Reimbursement Account (HRA).

This form is not required to be submitted with an Application.

Complete the hierarchy information for each agent contracting with Security Benefit Life Insurance Company (SBL). This sheet must accompany all new contracting agreements. List all hierarchy levels including the agent/agency.

This form must accompany any request for the Home Healthcare Doubler and be fully completed and signed by both the owner and authorized physician.

This form is used to request Annual Income payments under the Rising Income Rider of your Contract.
Refer to the Guide to Understanding the Income Election Form for additional details.

Note the following: