These forms will be of use to those insured through Bethany Benefit Service who need to add or update information or who need to terminate coverage. To enroll in Bethany Benefit Service, please call (800) 313-8955 or email 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 Bethany Benefits and Covenant Pension with any related questions.
email:  |  phone: (800) 313-8955  |  fax: (773) 784-2249