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 
P.O. Box 3016

Monroe, WI 53566-3016

(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.

Please send all correspondence (letters or policy forms) to our post-office box in Monroe, WI. Please note that mail sent to our parent company's Chicago address will be delayed as it will need be forwarded to our processing team. To track your shipment, the US Postal Services' Priority or Express Mail is recommended as other shipping carriers do not deliver to post-office boxes.  Premium payments should be sent using the self-addressed envelope included with your statement.