With FastApply AD&D, you can apply in three minutes or less.

  • No health questions asked
  • Designed to be affordable
  • Acceptance is guaranteed

Apply for your no-cost AD&D coverage

Your credit union picks up the cost as a benefit of your membership with them. Fill out this simple form, and off you go.

* denotes required fields.

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Beneficiaries

Naming a beneficiary means money can go directly to someone you choose. You can name more than one beneficiary and divide the funds. You may also add contingent beneficiaries: those who will collect benefits should each primary beneficiary be deceased. Or, you can select ‘No Thanks’ and we will pay benefits according to the policy. Click ‘View Product Details’ at the right for more information on coverage and beneficiaries.

Primary Beneficiaries

    Add Primary Beneficiary
    % Your list of primary beneficiaries and contingent beneficiaries must each add up to 100%.

    Contingent Beneficiaries

      Add Contingent Beneficiary

      Confirm Coverage

      You have accepted  of no-cost coverage.

      Did you know that you can add more TruStage AD&D coverage from CMFG Life Insurance Company? It can be just for you, or include your spouse and/or children. It could be a good idea to add coverage to an AD&D policy. Additional coverage could mean more resources for bills, debts, or even a mortgage payoff.

      And when you discover how inexpensive it can be to increase your coverage, you might realize that adding to your coverage now simply makes sense.


      How does coverage work?

      Payment

      Choose your payment method below. Remember, we can conveniently deduct the premium right from your credit union account.

      You've selected as your financial institution. If this is incorrect, please re-enter the routing number.
      You will be billed directly
      On enrollment, you will be billed on  of the month, .
      *required

      Summary

      Please review the information below carefully. To make a change, just click "Edit". Also, please review Important Information at the bottom of the page and click "Accept & Submit."

      My AD&D Coverage

      • No-Cost Coverage:
      • Additional Coverage:
      • Monthly Premium:
      • Plan Type:
      Edit

      Beneficiary Information

      Primary Beneficiary

      Contingent Beneficiary

      Edit

      Contact Information

      •   
      •   
      • Phone:
      • DOB:
      • E-mail:
      Edit

      Payment Information

      • Account Type:
      • Financial Institution:
      • Account #:
      • Routing #:
      • Payment Frequency:
      • Payment Date: After the effective date of coverage, we will debit your account in the amount of  on day  of the month, on a  basis.
      • Account Type:
      • Financial Institution:
      • Account #:
      • Routing #:
      • Payment Frequency:
      • Payment Date: After the effective date of coverage, we will debit your account in the amount of  on day  of the month, on a  basis.
      • Credit Card #:  ending in 
      • Expiration Date:
      • Cardholder:
      • Payment Frequency:
      • Payment Date: After the effective date of coverage, we will charge your account in the amount of  on day  of the month, on a  basis.
      Edit

      AD&D Important Info

      Print
      The "I Accept" button at the bottom of this page is very important. When you click it, you're agreeing to all the information shown below, legal details and requirements of electronic transactions, communications, and signatures. You're also agreeing to other important terms and conditions, preauthorized payments and more. Please take a few minutes to review this information and read it thoroughly. If you have any questions or need any assistance, please call us at 1-888-787-8243.
      ______________________________________________________________

      IMPORTANT INFORMATION

      By selecting the "I Accept" button at the bottom of this page, you acknowledge that you have reviewed this information and wish to proceed with enrollment. Accidental Death & Dismemberment Insurance is underwritten by CMFG Life Insurance Company (CUNA Mutual Insurance Society in California and New Mexico), ("the Company").

      Consent and Agreement to Electronic Transactions / Electronic Signature

      By clicking "I Accept" below, you consent to conduct transactions in electronic form. This can include the use of electronic communications, electronic records, electronic signatures for the communications, and electronic notices and disclosures described below.

      You also acknowledge that:
      •You can access and read this Consent and Agreement to use Electronic Signature and Electronic Delivery of Information.
      •You can print this Consent and Agreement.
      •Your electronic signature is the legal equivalent of your written signature, just as if you had signed a paper document.

      You are not obligated to enter into transactions electronically and may conduct insurance transactions in paper format instead.

      It is your responsibility to provide us with an accurate email address as well as other contact information. It is also your responsibility to inform us of any changes in this information.

      If you choose to conduct insurance transactions in paper form, withdraw your consent to electronic transactions, or to would like to update your contact information, please contact CMFG Life Insurance Company. You can call us toll-free at 1-888-787-8243 or write to CMFG Life Insurance Company, P.O. Box 61, Waverly, IA 50677-0061. There is no fee charged for such requests.

      You agree that your electronic signature authorizes the Company to do the following:
      •Electronically process this insurance transaction and any future transactions that may be needed to administer and help keep your coverage in force under the insurance policy.
      •Communicate with you by mail, telephone or email.

      You consent to use electronic communications, electronic records and electronic signatures rather than paper documents for:
      •agreements and contracts, including this Consent and Agreement.
      •notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you.
      •notices, documents, statements, data, records or communications regarding your coverage, including changes in terms of coverage.
      •privacy policies and notices.
      •periodic billing or account statements.

      You understand and agree that this election provides consent to the Company to deliver all notices electronically, including notice of nonrenewal and notice of cancellation. To ensure uninterrupted communication, please be sure to update the email address you provided to the Company in the event this email address should change.

      You understand and agree that in order to access the documents we send to you electronically, a minimum standard of technology is required, The fully functional hardware, software and services necessary include a computer with a Microsoft Windows or Macintosh operating system, Internet access, a working email address and email software, compatible web-browsing software such as Internet Explorer and Internet access services. You understand that you will be deemed to have received the foregoing documents even if you fail to provide the necessary technology.

      A confirmation email will be sent to you upon completion of your enrollment. Please note that after you enroll, you will not have access to your electronic enrollment record. We encourage you to print your enrollment record, including this Important Information, at the time of enrollment.

      Additional Terms and Conditions
      •Your credit union enables this insurance program to be offered and is entitled to compensation from the Company for doing so.
      •You acknowledge and agree that the information you have provided is true and accurate and that you are a member of the credit union you designated.
      •You cannot be the insured under more than one no-cost certificate/policy per credit union. Upon discovery of duplicate enrollment, the duplicate will be voided and coverage will not take effect.

      Preauthorized Payment Authorization

      By clicking "I Accept" below, you authorize the Company to retain your account information and deduct premiums from your checking or savings account or charge your credit card for the additional coverage as indicated above in the Enrollment Summary.

      Fraud Notice

      Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance may be guilty of a crime and subject to fines and confinement in prison, and denial of insurance benefits, depending on state law. Residents of CO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies. Residents of DC–WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. Residents of FL and NY: See enrollment form. Residents of AL and MD: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Residents of NJ: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Residents of OH: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Residents of KY and PA: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

      The certificate provides limited benefits. Review your certificate carefully.

      E10f-014-2012-WEB

      CMFG Life Insurance Company
      P.O. Box 61, Waverly, IA 50677-0061
      1-888-787-8243

      Thank you for enrolling in AD&D coverage.

      You've taken an important step in protecting the achievements and aspirations of the people who matter most in your life. Please print out the following for your records. You will receive a policy in the mail officially verifying your coverage. If you have any questions call us at 1-888-888-0375.

      yellow ribbon

      You may also be eligible for other TruStage insurance products and programs. Be sure to find out more at www.TruStage.com.



      Enrollment Summary Print

      Your Confirmation Number: 

      My AD&D Coverage

      • No-Cost Coverage:
      • Additional Coverage:
      • Monthly Premium:
      • Plan Type:

      Contact Information

      •   
      •   
      • Phone:
      • DOB:
      • E-mail:

      Beneficiary Information

      Primary Beneficiary

      Contingent Beneficiary

      Payment Information

      • Account Type:
      • Financial Institution:
      • Account #:
      • Routing #:
      • Payment Frequency:
      • Payment Date: After the effective date of coverage, we will debit your account in the amount of  on day  of the month, on a  basis.
      • Account Type:
      • Financial Institution:
      • Account #:
      • Routing #:
      • Payment Frequency:
      • Payment Date: After the effective date of coverage, we will debit your account in the amount of  on day  of the month, on a  basis.
      • Credit Card #:  ending in 
      • Expiration Date:
      • Cardholder:
      • Payment Frequency:
      • Payment Date: After the effective date of coverage, we will charge your account in the amount of  on day  of the month, on a  basis.

      AD&D Important Info

      The "I Accept" button at the bottom of this page is very important. When you click it, you're agreeing to all the information shown below, legal details and requirements of electronic transactions, communications, and signatures. You're also agreeing to other important terms and conditions, preauthorized payments and more. Please take a few minutes to review this information and read it thoroughly. If you have any questions or need any assistance, please call us at 1-888-787-8243.
      ______________________________________________________________

      IMPORTANT INFORMATION

      By selecting the "I Accept" button at the bottom of this page, you acknowledge that you have reviewed this information and wish to proceed with enrollment. Accidental Death & Dismemberment Insurance is underwritten by CMFG Life Insurance Company (CUNA Mutual Insurance Society in California and New Mexico), ("the Company").

      Consent and Agreement to Electronic Transactions / Electronic Signature

      By clicking "I Accept" below, you consent to conduct transactions in electronic form. This can include the use of electronic communications, electronic records, electronic signatures for the communications, and electronic notices and disclosures described below.

      You also acknowledge that:
      •You can access and read this Consent and Agreement to use Electronic Signature and Electronic Delivery of Information.
      •You can print this Consent and Agreement.
      •Your electronic signature is the legal equivalent of your written signature, just as if you had signed a paper document.

      You are not obligated to enter into transactions electronically and may conduct insurance transactions in paper format instead.

      It is your responsibility to provide us with an accurate email address as well as other contact information. It is also your responsibility to inform us of any changes in this information.

      If you choose to conduct insurance transactions in paper form, withdraw your consent to electronic transactions, or to would like to update your contact information, please contact CMFG Life Insurance Company. You can call us toll-free at 1-888-787-8243 or write to CMFG Life Insurance Company, P.O. Box 61, Waverly, IA 50677-0061. There is no fee charged for such requests.

      You agree that your electronic signature authorizes the Company to do the following:
      •Electronically process this insurance transaction and any future transactions that may be needed to administer and help keep your coverage in force under the insurance policy.
      •Communicate with you by mail, telephone or email.

      You consent to use electronic communications, electronic records and electronic signatures rather than paper documents for:
      •agreements and contracts, including this Consent and Agreement.
      •notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you.
      •notices, documents, statements, data, records or communications regarding your coverage, including changes in terms of coverage.
      •privacy policies and notices.
      •periodic billing or account statements.

      You understand and agree that this election provides consent to the Company to deliver all notices electronically, including notice of nonrenewal and notice of cancellation. To ensure uninterrupted communication, please be sure to update the email address you provided to the Company in the event this email address should change.

      You understand and agree that in order to access the documents we send to you electronically, a minimum standard of technology is required, The fully functional hardware, software and services necessary include a computer with a Microsoft Windows or Macintosh operating system, Internet access, a working email address and email software, compatible web-browsing software such as Internet Explorer and Internet access services. You understand that you will be deemed to have received the foregoing documents even if you fail to provide the necessary technology.

      A confirmation email will be sent to you upon completion of your enrollment. Please note that after you enroll, you will not have access to your electronic enrollment record. We encourage you to print your enrollment record, including this Important Information, at the time of enrollment.

      Additional Terms and Conditions
      •Your credit union enables this insurance program to be offered and is entitled to compensation from the Company for doing so.
      •You acknowledge and agree that the information you have provided is true and accurate and that you are a member of the credit union you designated.
      •You cannot be the insured under more than one no-cost certificate/policy per credit union. Upon discovery of duplicate enrollment, the duplicate will be voided and coverage will not take effect.

      Preauthorized Payment Authorization

      By clicking "I Accept" below, you authorize the Company to retain your account information and deduct premiums from your checking or savings account or charge your credit card for the additional coverage as indicated above in the Enrollment Summary.

      Fraud Notice

      Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance may be guilty of a crime and subject to fines and confinement in prison, and denial of insurance benefits, depending on state law. Residents of CO: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies. Residents of DC–WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. Residents of FL and NY: See enrollment form. Residents of AL and MD: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Residents of NJ: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Residents of OH: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Residents of KY and PA: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

      The certificate provides limited benefits. Review your certificate carefully.

      E10f-014-2012-WEB

      CMFG Life Insurance Company
      P.O. Box 61, Waverly, IA 50677-0061
      1-888-787-8243

      Accepted on 2/6/2016 7:14:46 AM E10f-014-2001-WEB
      TruStage Accidental Death and Dismemberment insurance (underwritten by CMFG Life Insurance Company) features guaranteed acceptance and no medical questions.