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Access the sample certificates you need.
OMA Priority Insurance Program
OPIP Health, Health plus rider & HCSA sample certificate (PDF)
OPIP Critical Illness Insurance sample certificate (PDF)
Atlantic Benefits Program
Health & Health Plus Insurance sample certificate (PDF)
Health & Dental Insurance
Health & Health Plus Insurance sample certificate (PDF)
Dental & Dental Plus Insurance sample certificate (PDF)
Disability Insurance
Disability Insurance sample certificate (PDF)
Critical Illness Insurance
Critical Illness Insurance sample certificate (PDF)
Accident Death & Dismemberment Insurance
Accidental Death & Dismemberment Insurance sample certificate (PDF)
Professional Overhead Expense Insurance
Professional Overhead Expense Insurance sample certificate (PDF)
Plan change form for the Physician Health Benefit Program (PDF)
Consent for authorized persons (PDF)
Request for cancellation of existing group insurance coverage (PDF)
Life event change form for Health and Dental insurance (PDF)
Request for change to existing group insurance coverage (PDF)
Application for change for OMA Critical Illness or Disability plans (PDF)
Life Forms
Authorization to provide information (PDF)
Group Membership Association Backdating/Save the Age Disclosure Notice (PDF)
Group Membership Association Beneficiary Change Request (PDF)
Group Membership Collateral Assignment of Release Form (PDF)
Request to Convert to Level Term to Age 100 (PDF)
Group Membership Disabled Child Continuation Form (PDF)
Application for Restoration of Coverage (PDF)
New York Life Insurance Non-Smoking Questionnaire (PDF)
Group Membership Change Request Form (PDF)
Group Membership Association Request for Identifying Information (PDF)
Group Membership Association Irrevocable Beneficiary Designation Waiver (PDF)
Request for the Child Dependent Rider Insurance from New York Life Insurance Company (PDF)