You must be a full or part-time Federal Employee to apply for Wright USA’s Disability Income Insurance Plan.

You may download, complete and return the application to the plan administrator at the address listed on the form. Be sure to answer all questions on the downloadable application and initial any changes.

California Residents Only: Click here to download your state’s application.

New York Residents Only: Click here to download your state’s application.

Residents of All Other States: Click the blue “Download Application” button immediately below.

If You Download the Application - Please Note: Your future Wright USA premiums can be paid automatically from your account at your financial institution on a Monthly, Quarterly, or Annual basis through Electronic Funds Transfer (EFT). To sign up for EFT: download, complete, and return our EFT Form along with your completed application.

If you are a New Hire (i.e., within 45 days of your Hire Date), you can Download, complete and return the enrollment form for our Guaranteed Acceptance plan (benefits are subject to the policy's pre-existing condition limitation) to the plan administrator at the address listed on the form. Be sure to answer all questions on the application and initial any changes.

Send No Money Now. You will be billed once you are approved or enrolled for coverage.

If you have any questions during the application (or enrollment for New Hires) process, please call 800-424-9801 for assistance.