Applications & Forms
All Applications may be viewed & printed with Adobe.
Applications
Medical Insurance for US-Citizen members only application
Medical Insurance for Non-US Citizen members application
International Life and Disability Insurance application
Application Instructions
1. Check the Insurance Plans page to locate the Plan of your choice. You'll find a description of Plan benefits. Please refer to this Plan description as you complete your Application, which is located here. Please complete it fully, being sure that it is signed and dated.
2. Do not send any money now. You will be billed once coverage is approved. The underwriting department will determine your premiums based on the medical questionnaire.
3. Scan your completed application to globalcare@rutherfoord.com
How You Can Help Make the Application Process Go Smoothly
When you fill out your application, make sure your answers are complete and detailed. Answer all questions, so processing of your application won't be delayed.
Complete medical information should include the name of physician(s) or hospital(s), street address (and suite or room number), city, state and zip code. Also include a brief description of the nature of an illness or injury, symptoms, treatment and results.
The insurance company underwriting your application relies on your answers and statements. Misstatements or failures to report information on your application may be used as the basis for denying or reducing claim benefits, or even invalidating your insurance.