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Beneficiary & Claim Forms

Beneficiary Form

Review and update your current beneficiary designations online in My Account. You may wish to complete a paper Beneficiary Designation form to make your designation, particularly if you have estate tax considerations or have needs that are more complicated that this online system allows. We strongly encourage you to consult the legal advice of an attorney in these instances. If you submit your beneficiary designation via a paper form, we will enter it into the NYL GBS Benefits Guide website so you can view it online through “My Account”.

Beneficiary Designation Form (English)

Beneficiary Designation Form (Spanish)

Claim Forms

The information requested in the form below is required for us to begin reviewing your claim. It's important that you provide us with complete and accurate information to avoid a delay in the processing of your claim.Return completed VTL claim forms to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193

Term Life Claim Form

Accelerated Payment Benefit Claim Form

Accidental Death & Dismemberment Claim Form
Enrollment & Change Forms

Application Form

If eligible, you can apply online for new coverage or increase existing voluntary coverage by clicking on Apply Now on the product page for the applicable product. However, you can also apply for coverage via paper application.

Application Form

Request for Change Form

Use this form to make changes to the features and benefits of your VTL and/or Voluntary AD&D (other than increasing coverage), including reducing your coverage or cancelling coverage for your children.

Request for Change Form
How and Where to Return Forms

Completed Beneficiary Forms or Change Forms can be returned to the NYL GBS Customer Service Center:

Mail to: NYL GBS Customer Service Center

Administered by Infosys McCamish Systems, LLC

PO Box 14577

Des Moines, IA 50306-3577

Email to: DSM_NYLGBSCustomerSupport@infymccservices.com

Completed Claim Forms can be returned to the address at the top of the form. For questions on filing a claim or completing the claim form, call 800.231.1193.