Only eligible AAFP members may apply. 

If you don't know your AAFP membership number or don't have one, click here.

BEFORE YOU BEGIN
Allow about 10 minutes to complete your application form.

Click here for a list of the personal information you will need to begin.

Once New York Life Insurance Company receives your application, you will be contacted by phone for your medical history. You will be advised if a medical exam, blood and urine samples, and/or additional health or financial information are needed. The exam and specimen collection will be conducted at a time and place convenient to you and at our expense.

HOW DO YOU WISH TO APPLY? (select one)

On-line Complete your application form on-line and submit it electronically.

• Once you begin, you will not be able to save a partially completed form and return back to it later.
  
• See below for list of computer hardware and software requirements needed to apply on-line.
     (You probably already have them installed on your laptop or desktop computer.)*
• If you previously transferred ownership of your coverage in the Traditional Term, Disability, and/or Practice Overhead plans, please use the “Paper-Pen-Postage” method to request changes to your current coverage.

Paper, Pen & Postage: Download & print a PDF; then complete, sign & mail it to us.

• Multiple Coverages Form
• Single Coverage Forms
  • 10-Year Level Term Life
  • 20-Year Level Term Life
  • Traditional Term Life
  • Disability
  • Disability (Uniformed Services Chapter members only)
  • Practice Overhead
    
    
• If you have any problems viewing or applying, please call us at: (800) 325-8166, between 8:30 am and 4:30 pm, Central Time.

*Additional Information:

For your security, this site is protected with 128-bit encryption. You must have a browser with this capacity to use this site.

• Best viewed with a screen resolution of 1280 x 800 or greater.
• Best viewed with a current version of IE, Chrome, Safari or Firefox browser. 
  Other browsers or older versions of these browsers are either not supported, or may not render an ideal user experience.
• NOTE: Due to the high benefit amounts offered, you may be contacted to have a medical examination, to submit blood and urine test, and/or to provide additional health or financial information in order to process your application.