Personal Life Insurance Interest Form

Open Enrollment for existing CBB participants is now closed for the 2026 enrollment period. There will be another Open Enrollment period starting January 2027. Individuals who were recently hired by their organization have a 30-day enrollment window to enroll in this benefit. If you were recently hired, please complete the Personal Life Insurance Interest Form to meet with an enrollment specialist.

A participant must be actively employed as a W-2 employee and working an average of 20 hours or more per week to be eligible.* The participant must be age 16 years through 80 years at the time of enrollment.

*This Personal Life Insurance product is only available to US-based employees who are not serving internationally.

Personal Life Insurance Interest Form

URL

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Birth Date(Required)

This data is being collected securely to verify that you are an active CBB participant.

Gender:(Required)

Full Employer Name:(Required)

Please do not use acronyms.

Employer City and State:(Required)

City State

Hire Date:(Required)