Employer Resources

Annuitization/Income Option Election Form

This is the Annuitization/Income Option Election Form. If needed, please complete and submit the form.
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Beneficiary and/or Name Change Form

This is the Beneficiary and/or Name Change Form. If needed, complete the form and submit to PGL. A copy will be provided to your employer. Please obtain copy from your employer for your personal record.
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Check Delivery Authorization Form

If you would like to have your check delivered to someone other than yourself, please complete this form in its entirety.
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Conversion Notice Form

This is the Conversion Notice Form. If needed, complete the form, make a copy for your files, and submit to PGL.
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Group Accelerated Death Benefit Claim Form

This is a claim for Group Accelerated Death Benefit Claim Form. The Insured/Claimant, Employer/Policyholder, and an Attending Physician are needed to complete the form.
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Group Accidental Death & Dismemberment (AD&D) Claim Form

This is a claim for Group Accidental Dismemberment or Loss of Sight Benefits. A Physician’s Statement is needed for the form’s completion.
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Group Life Absolute Assignment of Life Form

If you’re needing the Absolute Assignment of Life Form, you’ll need to complete three copies of the form.
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Group Life Application for Disability Benefits Form

The statement for the Group Life Application for Disability Benefits Form should be filled out by the employee. An Attending Physician’s signature is needed. The Physician can then mail the completed form to PGL.
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Group Life Death Claim Form

When submitting this form, also submit the insurance Certificate of Coverage, an original Death Certificate, the original Enrollment Card, and all Change of Beneficiary forms.
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Group Life Employee Enrollment Form

This form is for Group Life, Accidental Death & Dismemberment (ADD), and/or Long Term Disability Insurance (LTD) Enrollment. Please fill the form if needed, and send to Pacific Guardian Life.
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Group Life Evidence of Insurability Form

Please download, fill out completely, and mail the completed form to Pacific Guardian Life.
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Group Long Term Disability Claim Form

This form needs to be completed by the Employer, Employee, Doctor, and then be sent to PGL.
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TDI Portal Enrollment Form

Introducing Pacific Guardian Life’s (PGL) online Temporary Disability Insurance (TDI) billing feature available on Pono ‘Oe, our Employee Benefits portal.
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Temporary Disability Insurance (TDI) Application Form

Fill out this application to apply for Temporary Disability Insurance or TDI. This insurance is used for Employers to fulfill certain requirements.
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Temporary Disability Insurance (TDI) Claim Form

The Temporary Disability Insurance (TDI) Claim Form will need a Claimant’s Statement, Employer’s Statement, and Doctor’s Statement to be completed.
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Executive Bonus Plan

An Executive Bonus Plan (IRC SECTION 162) is an effective method for a business to pay the premiums on life insurance covering selected key employees or a business owner. The premiums are tax deductible by the Employer as a taxable bonus to the Employee.
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Group Term Life Insurance

This renewable term insurance coverage is the most common type of life insurance offered by employers. It provides a way for employers to obtain affordable life insurance for their employees and helps employees to protect their families’ assets.
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Key Person Insurance

Key Person Insurance is life insurance coverage on a select employee or owner to protect the continuation of the business.
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Long Term Disability Insurance

Long Term Disability (LTD) Insurance provides active employees with an income stream if they should become disabled and unable to work. Typically, LTD is meant to begin when short-term disability or temporary disability payments stop.
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TDI Fact Sheet

The Disability Compensation (DC) Division of the Department of Labor and Industrial Relations prepared this brochure to help you understand the Temporary Disability Insurance (TDI). Among other things, the brochure describes benefits, eligibility requirements for receiving benefits, how to file a claim, appeal rights, and other important points relating to the program. For more information,…
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Temporary Disability Insurance

Temporary Disability Insurance (TDI) is a “wage replacement” program that pays benefits to partially replace loss of wages due to off-the-job sickness or injury.
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Voluntary Accidental Death & Dismemberment Plus Insurance

Voluntary Accidental Death and Dismemberment Plus Insurance Nobody is ever prepared to handle an accidental death or the trauma of a crippling accident. Protect yourself and your family ﬁ nancially against such unpredictable events with Accidental Death and Dismemberment PLUS Insurance.
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Voluntary Term Life Insurance

Is your family protected from the financial consequences should you die prematurely? Voluntary Term Life (VTL) Insurance is a fast and convenient way to help protect your family’s future.
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Instructions to Complete Employer’s TDI Premium Statement 2018-2019

These are the instructions to complete the Employer’s Temporary Disability Insurance (TDI) Premium Statement. If needed, they’re downloadable and printable.
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Instructions to Complete Employer’s TDI Premium Statement 2022-2023

These are the Temporary Disability Insurance (TDI) instructions to complete the Employer’s Premium Statement. The reporting period is from 1/1/2022-1/1/2023. All information to be provided on the Employer’s Premium Statement pertains to this reporting period.
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Instructions to Complete TDI Claim Form

Employers should complete this form with help from their employee and their employee’s physician.
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