Lincoln Republic Insurance Company is now    Medico Life and Health Insurance Company

Effective July 1, 2015, Lincoln Republic Insurance Company is now Medico Life and Health Insurance Company.  It is now a member of the Medico family of companies, and it remains an affiliate company of American Enterprise Group, Inc.  Policyholders should receive communication about the name change and what it means for any policy formerly issued or administered by Lincoln Republic Insurance Company.

The forms on this page are for use only for policies formerly issued or administered by Lincoln Republic Insurance Company.  To request service on your policy, please select from the following or scroll down the page:

Submit completed forms by mail to:

Medico Life and Health Insurance Company
P.O. Box 10386
Des Moines, IA 50306-0386

Completed forms can also be faxed to 515-247-2435.

Voluntary Group Life (VGL) Rates

If you have questions regarding the Voluntary Group Life (VGL) rates, please contact us at
1-800-228-6080.


Policy Maintenance

Group Policies

Employer Forms

Employee Forms

Use these forms to make changes to the coverage of your employees.

For employees under an employer group, changes to your policy may require additional information held by your employer or a signature for approval. Talk with your employer representative for help.

Employee Enrollment Forms

Individual Policies


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File a Claim

Group Policies

Employer & Employee Forms

For employees under an employer group, changes to your policy may require additional information held by your employer or a signature for approval. Talk with your employer representative for help. The Employer, insured Employee, and attending physician must complete and submit the appropriate form immediately.

Statement of Death

Please note upon the death of an insured employee, please complete the beneficiary and employer forms below:

Individual Policies

For individuals whose policy is not through an employer, each beneficiary must complete the form below:


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Portability and Conversion

VGTL Portability

Continue your Voluntary Group Term Life (VGTL) coverage when you become ineligible through your employer. By applying for portability of your current VGTL policy you will:

  • Receive the group rate discount for your age
  • Have coverage regardless of your physical condition
  • Continue coverage for eligible spouse and dependents
  • Be able to customize your amount of coverage

Please complete your Portability Application and return it to the mailing address listed at the top of this page:

Group Life Conversion

If you become ineligible for your employer's Group Life Insurance coverage, you can convert your group plan to a Whole Life Insurance plan. By converting your current Group Life to a Whole Life plan, you will:

  • Have coverage regardless of your physical condition
  • Lock in a rate that won't increase
  • Continue coverage for eligible spouse and dependents

Please complete your Conversion Application and return it to the mailing address listed at the top of this page:


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To Find Which of the Following Products Are Available in Your Area: