How To Apply for Coverage

To download applications for coverage, please check each box to indicate the coverage(s) requested, and provide your name, e-mail and phone number including area code below. You will need to complete a separate application(s) for each coverage and a payroll deduction authorization form.

Applications and payroll deduction authorization must be completed, signed and returned by mail to:

CSEA Insurance Program
C/o Pearl Carroll & Associates, LLC
12 Cornell Road
Latham, NY 12110

Or

If you wish, you can contact one of our representatives directly at
1-800-929-6656 – Mon-Fri 8AM-5PM.
For Universal Life Plan and Group Whole Life contact your Pearl Carroll & Associates representative, toll free 1-800-929-6656.

Please select the application forms that you would like to download and then complete the required information below:

Term Life Premier Plan
Critical Illness
Disibility

First Name:

Last Name:

Email Address:

Phone Number:





Before completing an application, be sure to review the plan information for eligibility, options and a complete description of the coverage. This coverage is only available to dues paying members.

Coverage cannot be bound or made effective until review, underwriting and approval of your completed application by the insurance company. Pearl Carroll & Associates is licensed to sell insurance in most states. This is not a solicitation for insurance in any state where Pearl Carroll & Associates is not licensed to sell insurance policies. Please click here for a listing of our licensing by state.