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To change or correct TCA Accountholder name and address. To add or change beneficiaries on your Total Control Account.Ĭhange Accountholder’s Name or Address of Record Please verify that your employer's plan offers electronic funds transfer for disability income benefit payments before submitting this form to MetLife. Have the physician complete this form after you file your claim.Ĭertification for Employee's Serious Health ConditionĬertification for Family Member's Serious Health ConditionĬertification for Qualifying Exigency for Military Family LeaveĬertification for Covered Service-member for Military Family LeaveĮlectronic Funds Transfer (EFT) Authorization FormĬomplete, sign and mail/fax this form to MetLife to authorize electronic funds transfers of your disability insurance payments directly to your bank. These forms are used to gather medical information necessary for the ongoing management of Family and Medical Leave Act (FMLA) Claims for yourself, a family member or a service-member family member. Have your physician complete this form when your case manager requests new/updated medical information. This form is used to gather medical information necessary for the ongoing management of disability claims. Use the form to inform your physician(s) that MetLife will be administering your disability claim and give authorization to release your medical information to MetLife.
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Medical Authorization/Disclosure of Information Use this form for a change of Beneficiary and Spousal Consent for ERISA or Non-ERISA 403(b). Use this form if you were impacted by SARS-CoV-2 or COVID-19 and are eligible to take a distribution as defined by the CARES Act. This form is for a participant or alternate payee to request a distribution from a 403(b) Non-ERISA annuity other than for a hardship or as a systematic withdrawal. This form is for use by an Administrator to change Group Participant information (e.g., name changes, deletions, corrects, etc.).Ĥ03(b) Withdrawal Request Form - Non-ERISA Make Corrections to Group Participant Information Use this form to correct, change or designate your beneficiaries. Then mail or fax it to us at the address or number provided.
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Download and complete the appropriate form below.