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Covenant Benefits Addition, Update, and Termination Forms

These forms will be of use to those insured through Covenant Benefits who need to add or update information or who need to terminate coverage.

To enroll in Covenant Benefits, please call (800) 313-8955 or email benefits@covchurch.org for an application

Dependent Addition form – Download now

Health Insurance Addition Form – Download now

Life and Long-term Disability Insurance Addition Form – Download now

Life Beneficiary Update Form – Download now

Spouse or Child Coverage Termination Form – Download now

Termination of Benefits or Employment Form – Download now

Transfer of Benefits Form – Download now

Waiver of Health Insurance Form – Download now

Contact Covenant Benefits with any related questions.
email: benefits@covchurch.org  |  phone: (800) 313-8955  |  fax: (773) 784-2249

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