Death Claims

Remember to complete any applicable Employer's section(s) before distributing forms to beneficiaries.

Frequently Asked Questions for Death Claims

When you provide the claim form to the beneficiary(ies) to sign, you must also provide the Voya™ Personal Transition Account Supplemental Contract to each beneficiary. Not applicable to beneficiaries residing in Alaska, Illinois, Kansas, North Carolina, or Nevada.

If a trust is named as the beneficiary, the Trust Verification form must be completed by the trustee.

Form Form Number

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in Arkansas, Indiana, Kentucky, Louisiana, North Dakota, or Rhode Island

159971 (rev 9/01/14)
159729 (rev 9/01/14)

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in California, Florida or Minnesota. ALSO USE IF INSURED RESIDED IN MINNESOTA AT TIME OF DEATH OR FOR POLICIES ISSUED OR SITUSED IN MINNESOTA

159816 (rev 9/01/14)
159729 (rev 9/01/14)

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in New York. ALSO USE FOR POLICIES ISSUED OR SITUSED IN NEW YORK

115813 (rev 9/01/14)
159729 (rev 9/01/14)

Claim form for beneficiaries OR for Employers opting out of Voya Transition Account

159815 (rev 9/01/14)

Claim form and Voya Personal Transition Account Supplemental Contract for beneficiaries residing in all other states

115446 (rev 9/01/14)
159729 (rev 9/01/14)

Trust Verification

142020 (rev 9/01/14)

Voya™ Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the Voya™ family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.