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If you are a California resident, please read our Notice at Collection.

Please note:

By entering your name, phone number, and clicking "Submit," you are

1) electronically signing this form and

2) consenting to Combined Insurance ("our," "us" or "we") making autodialed calls to you at the landline or wireless phone number(s) you provide.

You are not required to provide such consent as a condition of purchasing Combined Insurance products.

This consent will not be available in paper form; you are encouraged to print this form for your records.

This consent only authorizes us to call you at the phone number(s) you provide in response to this request for information.

If you wish to inquire about Combined Insurance products without submitting your information online, call us at
1-800-490-1322.

Our customer service representatives are available during usual business hours and ready to help.

All US Except New York

Toll-free: +1 800-225-4500

Fax: +1 312-351-6940

Monday through Friday 7:30am – 6pm CST

Globe Life Insurance Companies products:

New York Residents/Policyholders

Toll-free: +1 800-951-6206

Fax: +1 312-351-6940

Monday through Friday 8:30am – 6pm EST

Worksite Customers

North America
Europe
Asia Pacific

About Combined Insurance
Combined Insurance Company of America, a Chubb company, is a leading provider of supplemental health, accident, disability and life insurance products for employers of all sizes and individuals. Building on over 100 years of success, the company operates under two brands. The Combined brand in the U.S. and Canada provides supplemental benefits to individuals and small businesses through independent agents and brokers. Our Chubb Workplace Benefits division caters to mid- and large-market employers sold through brokers and benefits consultants. Combined Insurance Company of America and Combined Life Insurance Company of New York have an A+ rating by the Better Business Bureau and an A + (Superior) financial strength rating by AM Best. In New York, products are underwritten by Combined Life Insurance Company of New York (Latham, NY).