Colonial Supplemental Insurance
ColonialConnect for Plan AdministratorsSM Web Site Access
  
If you handle the administration of your company's Colonial account bill and would like to take advantage of a secure web site for plan administrators, please complete a request form.

Important Notice: If your organization uses spam filtering software, please allow incoming messages from ColonialConnectSrvsCtr@unumprovident.com. If you have any questions, please contact your systems administrator.

* indicates required fields
 

Request Access For the Plan Administrator Web Site
Account Name *
Account Billing Control Number *
Additional Account Billing Control Numbers:
First Name *
Middle Initial *
Last Name *
Phone Number * - -   ext.
Your E-mail Address *
Re-Enter Your E-mail Address *
What is your relationship? *
If "Other" please explain: 
What is your preferred 
method to receive your 
Member ID and Password? * 		E-mail US Mail
Are you interested in learning more about Ez Billing?  Yes No
How did you hear about the ColonialConnect for Plan AdministratorsSM web site?
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"Colonial Life," the logo and "making benefits count," separately and in combination, are registered service marks of Colonial Life & Accident Insurance Company. All rights reserved.

Colonial Life products are underwritten by Colonial Life & Accident Insurance Company. Coverage has exclusions and limitations that may affect benefits payable. Coverage may vary by state and may not be available in all states. See your representative for complete details. Colonial Life is the marketing brand of Colonial Life & Accident Insurance Company.