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 1419
Charlotte NC 28201-1419

(800) 959-3894

(855) 784-1586


Attention Illinois residents:
Cook, Kane, Lake, and McHenry counties, in Illinois, have been declared state disaster areas.
Equitable is offering temporary relief to affected policyholders.
All group insurance products are issued either by Equitable or Equitable America, which have sole responsibility for their insurance and claims-paying obligations. Some products are not available in all states.