Application Information for Member

All applicants must be union members in good standing and available to work on the effective date of their coverage.

Questions during enrollment?
Call Kocher Insurance Group at 888-212-7822.

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* INDICATES required FIELDS

Insurance coverage is provided under the terms of a group life insurance policy, Group Policy #70696-5-6, issued and delivered in the state of Illinois to Midwest Coalition of Labor – Chicago Laborers District Council as the policyholder. The group life insurance policy is issued by ReliaStar Life Insurance Company, Minneapolis, Minnesota. Coverage may not be available in all states. Contact Kocher Insurance Group at 888-212-7822 for further details. Policy form ICC LP14GP or LP00GP (may vary by state).