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Effective immediately: Changes to life applications and HIPAA forms
June 28, 2022

To provide a better customer and agent experience, Protective has updated the paper life insurance application form, PL-400, as well as the Premium Payment Allocations form used for Protective® Strategic Objectives II VUL. These changes provide a cleaner layout making it easier to complete the forms.

Additionally, Protective has updated the HIPAA form to be more specific regarding the types of data that may be collected during the application process.

The new versions of these forms are now required. Old versions of the forms will be honored only through July 1, 2022.

For ticket/TeleLife applications, Protective will honor the forms included in application packet regardless of when the application is signed.

The new forms have been added to for your convenience. Going forward, please be sure to discard any saved forms that may be outdated.

If you have any questions about changes to these forms, contact your Protective representative.

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