Clients

Liberty Union Life is pleased to have you as a Client. On this page you will find various commonly used documents and forms. Simply click on the document name below to view each file.

COBRA ARRA SUBSIDY INFORMATION FOR ALL EMPLOYERS

Forms & Downloads
Liberty Union Life Insurance Certificate
LifeStyles Change Form
Disabled Dependent APS Form
Conversion Policy
Michigan Diabetes Statement
Women's Cancer Annual Notice
Disability Statement of Claim Form
Personal Identification Form
Eligibility Questionnaire Form
Full-time Student Status Confirmation Form
Change of Address Form
Subrogation Assignment Form
Fully Insured Authorizations for Release of PHI Form
Designated Representative Fully Insured Form
Liberty Union Employee Application (Groups Under 50 People)
Liberty Union Employee Application Over 50 (Groups Over 50 People)
Liberty Union Individual Policy Employee Application
Lifestyles Employee Application
MAA Self Funded Authorization to Release PHI Form
Dental Enrollment Form
Caremark Mail Order Form
Caremark Reimbursement Form
Liberty Union Privacy Statement
Liberty Union Group Change Form

Already a Liberty Union Life member?

We're glad to have you! This website is your direct access to Liberty Union. Customer service contacts, your Group Insurance Certificate and online form library are here when you need them ... 24 hours a day, 7 days a week.

Check your Claims Status, Policy and Enrollment Information by clicking here.

Looking for a Doctor or Hospital?

You can access the COFINITY Network lookup system by clicking here.