120 Royall Street - Canton, MA 02021 Phone: (800) 669-2668 Fax: (781) 770-0490

 

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Group

- On-Line Administration

 

Forms > Group Administration

Group Administration Forms

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At Boston Mutual Life Insurance Company, we strive to make our customers' lives easier. Below, you will find many of our administrative forms that can be downloaded for your convenience. Please select the link that best describes your needs. If you are unable to locate a required form, please call 1-800-669-2668 ext 382.

Employers/Plan Administrators - please mail completed forms with your premium payment to the following address:

Boston Mutual Life Ins. Co. -G
PO Box 55154
Boston MA 02205-5154

The forms can also be mailed to:

Boston Mutual Life Insurance Company
Group Administration
120 Royall Street
Canton MA 02021

OR

Fax to 781-770-0575

OR

Email Email us

The Boston Mutual Group Administration Toll Free number is
1-800-669-2668 EXT 700.

Group Administration Forms
Group Enrollment Forms
(REFUSAL OF INSURANCE)
Evidence of Insurability
Authorization of Release of Health Related Information Notice of Information Privacy Practice
Conversion
Portability
Group Insurance Request for Change
Group Insurance Certificate Change Form
Includes Beneficiary Changes
Group Insurance Self Administration Premium Report
Supply Request Form
HIPAA Notice of Privacy Practices for Certain Products
Medical Expense Reinbursement Product
True Group Voluntary Dental Product (limited to PA)