What is this for?
For enrollment or termination from Zurich Employer Paid Short-Term and Long-Term Disability
For enrollment or termination from Zurich Employee Paid Short-Term and Long-Term Disability
Selecting coverage options for employer groups electing to offer short-term and/or long-term disability
To enroll in certain long-term or short-term disability plans more than 31 days after starting your job
Send completed form to firstname.lastname@example.org, fax to (800) 206-4063, or mail to Zurich Medical Underwriting, PO Box 1685, Grand Rapids, MI 49501-1685