Reinstatement forms - by state

Listed below are state specific Reinstatement forms and the required HIPAA and Financial Statement form. Please be sure to send all of these required forms with your Reinstatement request. If you do not see your state specific form listed, please use the Generic form.

Contact us

For questions or comments & policy inquiry:


U.S. Financial Life Insurance Company 
227 W Monroe St, Suite 3775

Chicago, IL 60606

(800) 959-3894

(855) 784-1586


Attention Illinois residents:
Cook, Kane, Lake, and McHenry counties, in Illinois, have been declared state disaster areas.

Heritage is offering temporary relief to affected policyholders.

All group insurance products are issued either by Heritage, which have sole responsibility for their insurance and claims-paying obligations. Some products are not available in all states.