Skip to content
Life Solutions
  • Home
  • About
  • Solutions
    • Life Insurance
    • Disability Insurance
    • Long Term Care
    • Annuities
  • Contact
  • Home
  • About
  • Solutions
    • Life Insurance
    • Disability Insurance
    • Long Term Care
    • Annuities
  • Contact
Life Solutions
  • Home
  • About
  • Solutions
    • Life Insurance
    • Disability Insurance
    • Long Term Care
    • Annuities
  • Contact
  • Home
  • About
  • Solutions
    • Life Insurance
    • Disability Insurance
    • Long Term Care
    • Annuities
  • Contact

Enroll or Make Changes

    • Plan 24035 Enrollment or Change Form

    • I understand that the effective date of my coverage will be delayed if I am not in active employment because of an injury, sickness, temporary lay-off or leave of absence on the date this insurance would otherwise become effective. By clicking the "yes" box I am certifying that I have read and understand the policy information provided, including all statements regarding exclusions.

    • (If you have not read the information, or do not understand portions of the information, click the "back arrow" on the tool bar to return to the information page. If you have additional questions call Kelley Phillips, Life Solutions, P.A., at 850-524-4240 , or e-mail [email protected].)

    • Plan 24035 Enrollment or Change Form

    • (ex: 30000 no commas)
    • 50% of salary

    • 40% of salary

    • 25% of salary

    • Yes, I want to participate. By submitting this form I authorize my employer to deduct from my salary or wages the necessary premium for this coverage and that all the information contained in this form is true and accurate.

    • This field is for validation purposes and should be left unchanged.

    PO Box 15698, Tallahassee, FL 32317  |  PHONE 1-850-524-4240   |  FAX 1-850-677-3376  |  EMAIL [email protected]

    © 2025 Life Solutions. All Rights Reserved.
    Website hosting and maintenance by WPTallahassee.