top of page

UCAP

Complete this form to enroll in or change your voluntary benefits for this upcoming year.

​

For Open Enrollment Only 

Effective January 1, 2026

Benefit Options

Enroll in Allstate Accident Policy?
Who would you like to enroll in Allstate's Accident Policy?
Which Allstate Accident Policy?
Enroll in Allstate Cancer Policy?
Who would you like to enroll in Allstate's Cancer Policy?
Which Allstate Cancer Policy?
Enroll in Unum Term Life Policy? (New EE GI 50K)
Enroll Spouse in Unum Term Life Policy? (New EE Spouse GI 25K)
Enroll Child in Unum Term Life Policy?
Who would you like to enroll in Allstate Universal Life Coverage?
Child 1 Gender
Child 2 Gender
Child 3 Gender
Child 4 Gender

SIP (Individual Disability Income Protection): You should have already received information about this.

DEMOGRAPHICS

Employee Gender
Spouse/Domestic Partne Gender
Child 1 Gender
Child 2 Gender
Child 3 Gender
Child 4 Gender

Thanks for submitting! If we have any additional questions, we will contact you directly!

Eastern Select Services

©2026 Eastern Select Services by Hately.Media.Designs

bottom of page