Personal Life Insurance Interest Form

Coverage is available for new employees and new churches who are enrolling with Church Benefits Board (CBB). There is a 30-day enrollment window to enroll in this benefit. Interested participants should complete the Personal Life Insurance Interest Form to meet with an enrollment specialist.

Open enrollment for existing Church Benefits Board participants is closed for 2026. The next group-wide open enrollment period is Monday, January 4 through Friday, February 26, 2027. During this period, all eligible employees may enroll in the benefit.

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

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)