Educator Benefits Solutions® form instructions

PDF Format Our forms are available in Portable Document Format (PDF). To view the forms, you may need to download the latest version of Adobe® Acrobat® Reader available at

Employer Master Application

This form is used by the employer for new business submission.

New Business Transmittal

This form is used at new business submission to accompany the master application.

Employee Application

This employee form is used when applying for Educator Benefits Solutions® coverage under their employer’s group insurance policy.

Portability Application

This employee form is used to continue the Educator Benefits Solutions® disability coverage for up to 12 months after employment ends.

Disability Claim Filing Form

This form is used to file Educator Benefits Solutions® long-term or short-term disability claims.

Marketing Materials Request

This employer form is used to request additional Educator Benefits Solutions® materials.

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