Downloadable Forms:

Presidential Life Insurance DBL Enrollment Form
HighMark Lide Insurance Company of New York Enrollment Form

Groups of 1-49 employees

For enrollment or additional information please contact FILCO by fax (212-972-1126), phone (212-972-1970), or online. dbl@filco.net.

The following information must be provided for a complete enrollment.

1) Company name and address
2) Form of Organization: Corp./Partnership/Proprietorship/Other
3) Employer Tax ID number (FEIN) and UI number
4) Total Number of employees to be insured: number males and number females
5) Proprietor/Partner: number of males and number of females
6) Does Employer deduct for DBL
7) Requested effective date.

Groups of 50 or more employees

Groups of 50 or more employees are experience rated please contact FILCO with the necessary information in order to obtain a quote. Phone (212) 972-1970, or fax (212) 972-1126, or e-mail at dbl@filco.net.

1) At least three years prior experience of premium and claims
2) Rae History - last two years
3) Current Carrier Name
4) Current Carrier Rate