Benefit Increase Pre-Application Questionnaire
Important Instructions - Please Read Before Proceeding
Thank you for taking this important step to review your disability insurance coverage. Your MassMutual policy includes the valuable Benefit Purchase Rider, which allows you to increase your coverage without medical underwriting every three years.
What You'll Need to Complete This Form:
- If employee: Your most recent paystub and most recent W-2
- If Independent Contractor, Partner or Solo Practice: Your most recent tax return
- Information about any other disability insurance policies you currently have
What Happens Next:
- Complete this form: Provide accurate information about your current income and any other disability coverage you have in force.
- Submit documentation: After completing this form, you’ll be prompted to upload your financial documentation (paystub, W-2, etc.).
- MassMutual review: Our team will review your information to determine your eligibility for additional coverage based on your current income and existing disability benefits.
- Receive your offer: If you financially qualify, you will receive a formal offer for additional disability coverage within 5-7 business days. This offer will specify the maximum monthly benefit increase you’re eligible for.
- Make your decision: You can choose to accept any amount up to the maximum offered increase. However, to maintain your Benefit Purchase Rider for future opportunities, you must accept at least 50% of the offered increase. Example: If MassMutual offers you a $2,000 monthly benefit increase, you would need to accept at least $1,000 to preserve your Benefit Purchase Rider for future use. If you accept less than $1,000, the rider will be permanently removed from your policy, and any future coverage increases would require full medical underwriting.
- Policy update: Once you’ve made your selection, MassMutual will process your request and update your policy accordingly. Your premium will be adjusted based on the additional coverage amount you accept.
This form is the first step in this important process. Your responses help us determine your eligibility for increased coverage without medical exams or health questions, regardless of any changes in your health since your policy was issued.
Please note: Your Benefit Purchase window is open for a limited time. Complete this form and submit your documentation promptly to ensure your request is processed before your window closes.