How to Submit a Case for Small Group Trust

Complete the following:

Small Group Participating Employer Application (GP1246-B-2003)
Small Group Premium Computation Sheet (GP1249)

You will be given the chance to print all of this information once you have completed the applications online.

Forward the above material along with a check for the 1st month's premium to:

The Lafayette Life Insurance Company
1905 Teal Road, P.O. Box 7007
Lafayette, Indiana 47903

Note:

Small Group Premium Computation Sheet (GP1249) is to be used in lieu of enrollment cards. Enrollment and/or beneficiary cards are available through our web site at www.LafayetteLife.com.
If you have any questions please call:

The Lafayette Life Insurance Company
Group Communications Center
1-800-952-8486

Now to actually obtain a quote, you need to login. If you do not have a Lafayette Life User Name and Password, please take about one minute to sign-up online, otherwise please login to calculate a quote.