State Life Insurance Fund Application

Last Updated: February 18, 2016​

Application Process

Eligibility

Life insurance policies are only available to persons who are residents of the state of Wisconsin at the time the application is submitted. Proposed insureds must be at least 14 days old before an application can be submitted on their life.

All five different policies are available to residents who are standard risks. Residents who are substandard risks are only eligible for an Ordinary Life policy.

Underwriting of the applications of substandard risks may require the Fund to seek information from MIB, Inc. and/or an investigative consumer report. This information will only be obtained if necessary.

The Fund is not required to provide insurance to all residents who apply. Consequently some substandard risks may not be eligible for insurance from the Fund. The Fund is required to operate in a manner consistent with private insurers with regard to policy coverage, medical examinations, and underwriting guidelines.

Medical Examinations

The Fund requires a medical exam for applicants who are 45 years of age or older. The Fund may request exams on other applicants. If a medical exam is required or requested, the applicant will be required to see a licensed physician. The Fund will pay a set fee for the exam.


​Application

Instructions for completing the State Life Insurance Fund (Fund) application form are included on the form. However, five important instructions should be noted:

  1. All questions in the application must be answered. The processing of the insurance will be delayed with incomplete responses.
  2. Enter the total annual premium on the application. For a $5,000 policy, the annual premium will be five times the rate per $1,000, etc. This must be entered on the application form even if you are paying quarterly or semiannually.
  3. State the full name of all beneficiaries. Do not list beneficiaries as "my wife," "my spouse," or "Mrs. Brown."
  4. If the person to be covered by the insurance is a minor, an owner must be designated.
  5. Mail the application form and premium to the State Life Insurance Fund, P.O. Box 7873, Madison, WI 53707-7873.

Use the e-mail address or telephone numbers at the bottom of this page to request an application or an application is available to be downloaded below.

State Life Insurance Fund Application     Application Español 


Address and E-mail Information:

State Life Insurance Fund
P.O. Box 7873
Madison, WI 53707-7873
(608) 266-0107 or 1-800-562-5558
ocislif@wisconsin.gov (please include your name and e-mail address)