LIFE INSURANCE FORMS
LIFE INSURANCE FORMS
AFTER 2025
Filing a Life Insurance Claim
Checklist for Surviving Family Members
Medical Evidence of Insurability Requirement (MEOI)
Medical History Statement (EOI) - Online Submission Instructions (This is the preferred method of submitting your Medical History Statement to MetLife Insurance Company.)
"If your life insurance coverage was active at the time your employment or LAwell benefits were terminated, MetLife will send you a Portability and/or Conversion packet with instructions on how to apply for continuation coverage. See the link below for more information. For any questions, please contact the MetLife Member Advocate at
(949) 471-2264 \ LAwell_LifeIns@metlife.com.
Portability & Conversion
Conversion Vs. Portability Brochure.
Imputed Income Forms
Imputed Income Fact Sheet (Revised 12/28/06)
Imputed Income Formula (Effective 01/01/06)
Accelerated Benefit Forms
Accelerated Benefit Claim Packet (leave ABO Employer's Statement section blank. Return to per.empbenefits@lacity.org.)
Travel Assistance Benefits
BEFORE 2025
Filing a Life Insurance Claim
Checklist for Surviving Family Members
Medical History Statement
Medical History Statement (EOI) - Online Submission (This is the preferred method of submitting your Medical History Statement to The Standard Insurance Company.)
Medical History Statement (EOI) - English (fillable & printable PDF)
Medical History Statement (EOI) - Spanish (fillable & printable PDF)
Portability & Conversion
Group Life Continuation: Portability & Conversion FAQ
Group Life Conversion Materials Request Form
Group Life Portability Insurance Application
Imputed Income Forms
Imputed Income Fact Sheet (Revised 12/28/06)
Imputed Income Formula (Effective 01/01/06)
Accelerated Benefit Forms
Accelerated Benefit Provisions
Accelerated Benefit Claim Packet
Legal Notices
Travel Assistance Benefits