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Electronic Document Consent

In order to provide electronic contracts and other documents, we are required by law to provide you with certain information and obtain your consent.

Section 1: Consent for Use of Electronic Documents
  1. Consent to Electronic Signatures and Documents: By providing your email address to us you agree that we may provide you with any information related to your insurance policy in electronic format, which includes but is not limited to applications for coverage, disclosures, notices, ID cards, policy contracts, benefits booklets (certificates) and addendums. By providing your consent, you are also confirming that you have the hardware and software described below, that you are able to receive and review electronic records, and that you have an active email account.
  2. Right to Receive Paper Documents: You have the right to have documents provided in paper form. If you prefer a paper copy of any document currently sent to you by email, please contact your account executive or account manager. Paper copies will be provided at no charge.
  3. Right to Withdraw Consent: You have the right to withdraw your consent to receive electronic documents by contacting your account executive or account manager. The legal validity and enforceability of the electronic documents and deliveries used prior to withdrawal of consent will not be affected.
  4. Minimum Hardware and Software Requirements: In order to receive electronic communications you must have all of the following:
  • Operating Systems: Windows 98, Windows 2000, Windows XP or Windows Vista; or Macintosh OS 8.1 or higher.
  • Browsers: Internet Explorer 5.01 or above or equivalent.
  • Needed Software/Electronic Document Formats: Adobe Acrobat Reader or equivalent for PDF files; Word program for Word files.

Section 2: Contact Information
First Name*
Last Name*
Email Address*
Group Name*