NTA Life Insurance Company of New York issues life, accident-only, specified disease, and disability income insurance policies, and is licensed in New York only. Availability from a particular company varies by product and state.

National Teachers Associates Life Insurance Company ('NTA Life') provides supplemental health insurance in addition to an existing employer plan. NTA Life also has comprehensive worksite benefits solutions.

Customer Service Center 1-888-671-6771 ntalife.com. National Teachers Associates Life Insurance Company. SEND THIS COMPLETED FORM TO THE CLAIMS PROCESSING CENTER BY: EMAIL: [email protected] . FAX: 1-855-512-5247 . MAIL: P.O. Box 2369 Addison, TX 75001-2369. Instructions:

contact our Customer Service Center, toll-free, at . 1.888.671.6771. One of our Associates will be glad to assist you. 10. 75-101-IN (4/17)

Customer Service Center 1-888-671-6771 ntalife.com National Teachers Associates Life Insurance Company SEND THIS COMPLETED FORM TO OUR ADMINISTRATIVE OFFICE BY: EMAIL: [email protected] FAX: 1-866-639 …

After completing the form, you may submit it to NTA Life in one of the following ways: Mail: P.O. Box 802207, Dallas, TX 75380 . Email: [email protected]. Fax: (866)639-2777

At NTA Life, we want to help prepare you for those unforeseen circumstances. Our accident policy provides benefits in addition to employer–sponsored coverage and pays you specific amounts for care and treatment of covered accidents.

I authorize National Teachers Associates Life Insurance Company, NTA Life Insurance Company of New York, or their affiliates, collectively “NTA Life,” to change the Payor on all policies listed above.

I authorize you to give NTA Life Insurance Company of New York and/or its reinsurers or its agents: (a) all information you have as to illness, injury, medical history, diagnosis, treatment and prognosis with respect to any physical or mental condition of the patient; and (b) any non-medical information about the patient which the Com -

Pay your NTA Life Insurance invoices online using our Express Payment Method without needing to create an online account!