In order to proceed with your enrollment in voluntary life insurance, there maybe a preapproval-prescreening process that we need to follow. To facilitate this, we have attached a form below, which you are kindly requested to fill out completely. Once you have filled out the form, please return it to the Mosaic HR Service Center at your earliest convenience.


Upon receiving your completed form, Mosaic will process your request, ensuring that your information is accurate and complete. Subsequently, your enrollment data will be forwarded to New York Life Insurance (NYL), the provider of our voluntary life insurance policies.


NYL will then take over the process and review your application. They will send you a formal letter, informing you of the status of your application, whether it has been approved or denied. Should your application be approved, your coverage will begin on the first day of the following month, and your paycheck deductions for the insurance premiums will begin at that time.


We understand that navigating insurance processes can be intricate, and we are here to support you throughout this journey. If you have any questions or require further assistance with the enrollment process, please don't hesitate to reach out to our HR Service Center. We are committed to ensuring that you have a smooth and successful enrollment experience.