Committed to the Federal Workforce

Group Long Term Disability Insurance Application

Fax: (410) 846-6420 | Email: | Mail: GEBA, 1362 Mellon Road, #100, Hanover, MD 21076

Before you begin to fill out GEBA’s Group Long Term Disability Application, we recommend that you have your medical records accessible for answering the health-related questions. You will be required to complete the entire application once you start since for security purposes we do not save the application for future access.

NOTE: GEBA’s Long Term Disability Insurance is not available to members who reside in Maine, New Hampshire, Vermont, and Oregon.

Group Long Term Disability Insurance is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010

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