How to Complete and Submit the Horace Mann 403(b) Withdrawal Form

To take money out of your Horace Mann 403(b), you complete form IA-004052, the annuity distribution request. Horace Mann does not post a blank copy for open download, so you request one by calling 800-999-1030 (Life, Retirement, Annuity and Group line, 7 a.m. to 7 p.m. CT, Monday through Friday) or by logging into My Account at horacemann.com. Completed forms go to Horace Mann Life Insurance Company, P.O. Box 4657, Springfield, IL 62708-4657.¹

How to Get the Form

You have three practical routes:

Call 800-999-1030 and ask for the annuity surrender/withdrawal request form (IA-004052). A representative can mail or email it to you.
Log into the My Account portal at horacemann.com. Depending on your plan, you may be able to initiate a distribution request electronically.
Ask your school district’s benefits office. Many districts keep Horace Mann forms on hand.

Before you sit down with the form, pull together your annuity contract number (it’s on your annual statement and any correspondence from Horace Mann), your Social Security number, your employer’s name, and a recent statement showing your vested balance. Transposing a single digit of the contract number can route your request to the wrong account and stall processing.

When You Qualify to Withdraw

Federal tax law limits when a 403(b) can be tapped. Horace Mann cannot release funds unless you meet at least one triggering event under IRC Section 403(b) and 26 CFR 1.403(b)-6:²³

You’ve reached age 59½. No justification needed after that.
You’ve separated from service (resignation, retirement, or layoff).
You’re disabled, meaning unable to engage in any substantial gainful activity because of a condition expected to last indefinitely or result in death. Horace Mann requires a physician’s certification for this reason.
You have an immediate and heavy financial need that qualifies as a hardship, with no other reasonably available way to cover it.
Death (your beneficiary receives the balance).

The IRS also recognizes qualified reservist distributions for military reservists called to active duty.⁴

One useful nuance if you’re between 55 and 59½: if you leave your employer during or after the calendar year you turn 55, distributions from that employer’s 403(b) escape the 10% early-withdrawal penalty under IRC Section 72(t)(2)(A)(v).⁵ This is the Rule of 55, and it applies only to the plan held with the employer you just left. Roll those funds to an IRA first and you lose the exception on that money.

Filling Out the Form

Form IA-004052 has several sections. Here’s what each one asks for and where mistakes tend to slow things down.

Personal and Contract Information

Enter your full legal name, Social Security number, date of birth, mailing address, phone number, email, and your Horace Mann annuity contract number. Cross-check the contract number against your most recent statement. You’ll also enter your employer’s name, typically your school district or nonprofit.

Reason for Distribution

Select the triggering event: age 59½, separation from service, disability, hardship, or another qualifying event. Disability claims require a separate physician’s certification confirming you meet the definition under IRC Section 72(m)(7).

Distribution Method

This is where the biggest financial decision sits. You choose among:

Direct rollover. Horace Mann sends the funds directly to another qualified plan or IRA. Nothing is withheld, and no current income tax is due because the money stays inside a retirement account.
Cash distribution. Horace Mann pays you by check or electronic transfer. Federal law requires 20% federal income tax withholding on any amount eligible for rollover, and you cannot opt out.⁶
Partial withdrawal. You take a portion of your vested balance. The same withholding rules apply to whatever you pull out.

For a direct rollover, you’ll need the receiving institution’s name, address, and your account number there. Get this information from your new custodian before filling out the form. An incomplete rollover section is one of the most common reasons Horace Mann returns paperwork.

Tax Withholding

For cash distributions, the 20% federal withholding on eligible rollover amounts is mandatory. You can, however, request additional voluntary federal withholding if you expect a higher tax bracket for the year. Educators taking a large lump sum at retirement sometimes find 20% doesn’t cover the actual bill, especially if the distribution lifts them into the 24% or 32% bracket.

State withholding depends on where you live. Some states set mandatory minimum rates for retirement distributions; states with no income tax require nothing. The form has a line for your state election. If you’re unsure, check your state revenue department’s guidance.

Signatures You May Need

Your own signature and date are the baseline. Beyond that:

Plan administrator. Horace Mann’s form instructions require plan administrator authorization for all 401(a) and 457(b) contracts, and for 403(b) contracts “if your plan requires it.”⁷ Many school district 403(b) plans do require it, as a way to verify that a qualifying event actually happened. Reach out to your district’s benefits coordinator early. Chasing a signature after you’ve mailed the form adds weeks.

Spousal consent. Most public school 403(b) plans are non-ERISA and generally aren’t subject to the federal spousal consent rules that apply to pension and ERISA plans. Some plan documents impose their own consent requirement, though, and Horace Mann’s form includes a spousal signature line. If you’re married, ask your plan administrator whether your spouse’s signature is needed. When it is, the signature typically has to be notarized or witnessed by a plan representative.

How to Submit

Mail the completed form to:

Horace Mann Life Insurance Company
P.O. Box 4657
Springfield, IL 62708-4657¹

To ask whether your plan accepts fax or electronic submission, call 800-999-1030. Availability depends on your specific plan. However you send it, keep a full copy of everything: the signed form, any physician certification, and the rollover details. Certified Mail, FedEx, or UPS gives you a delivery record, which is worth the small extra cost on paperwork of this size.

What Happens After You Submit

Horace Mann’s processing team reviews the form for completeness, verifies signatures, and confirms your requested amount doesn’t exceed your available balance. If something’s missing or inconsistent, they’ll contact you, which is why a current phone number and email on the form matter.

Horace Mann doesn’t publicly commit to a processing window. Plan documents generally allow administrators up to 90 days to act on a benefits claim, though straightforward requests with complete paperwork are usually processed well before that limit. A direct rollover goes to your receiving institution. A cash distribution arrives as a mailed check or an electronic deposit to the bank account you designated on the form.

After the distribution, Horace Mann issues a Form 1099-R for that tax year, reporting the gross distribution, taxable amount, and any federal and state tax withheld. You’ll need it when you file.⁸

The 10% Penalty If You’re Under 59½

If you take a cash distribution before age 59½ and don’t qualify for an exception, the IRS adds a 10% tax on the taxable portion of the withdrawal, on top of regular income tax.⁵ A $20,000 withdrawal can turn into a $2,000 surprise on your return, so it’s worth checking the exception list before you commit to a cash distribution.

The main exceptions that waive the 10% penalty include:

Distributions after age 59½
Separation from service during or after the year you turn 55
Total and permanent disability
Substantially equal periodic payments (72(t) payments)
Distributions to a beneficiary after your death
Qualified reservist distributions
IRS levy on the plan

Hardship distributions do not escape the 10% penalty. The hardship rules loosen when you can access the money, but if you’re under 59½ you still owe the additional tax.⁹ This catches people out.

Smaller-Dollar and Alternative Options

Sometimes the full withdrawal form isn’t the right tool for the situation.

SECURE 2.0 emergency withdrawal. Starting in 2024, you can take up to $1,000 per calendar year for an unforeseeable or immediate personal or family emergency, penalty-free and self-certified. Your vested balance must remain above $1,000 after the withdrawal. If you don’t repay the $1,000 within three years, you can’t take another emergency withdrawal until that window closes. Not every 403(b) plan has adopted this feature, so ask Horace Mann or your plan administrator whether it’s available on your contract.

Plan loan. If your employer’s plan allows loans, borrowing preserves the retirement balance. The IRS caps 403(b) loans at the lesser of 50% of your vested balance or $50,000.¹⁰ Some plans let you borrow up to $10,000 when 50% of your vested balance is less than that, though plans aren’t required to offer that floor. Horace Mann offers loans where the employer’s plan permits them, with an origination fee and an annual administration fee. You repay through payroll deduction, and staying on schedule keeps the loan from being treated as a taxable distribution. If you leave your employer before it’s repaid, the outstanding balance may be treated as a distribution, which pulls in income tax and, if you’re under 59½, potentially the 10% penalty as well.

1
Horace Mann. Horace Mann Mailing Addresses
2
Office of the Law Revision Counsel. 26 USC 403 – Taxation of Employee Annuities
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eCFR. 26 CFR 1.403(b)-6 – Timing of Distributions and Benefits
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Internal Revenue Service. Retirement Plans FAQs Regarding 403(b) Tax-Sheltered Annuity Plans
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Office of the Law Revision Counsel. 26 USC 72 – Annuities; Certain Proceeds of Endowment and Life Insurance Contracts
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Internal Revenue Service. Pensions and Annuity Withholding
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Horace Mann Life Insurance Company. Horace Mann Life Insurance Company Distribution Form Instructions
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Internal Revenue Service. About Form 1099-R, Distributions From Pensions, Annuities, Retirement or Profit-Sharing Plans, IRAs, Insurance Contracts, Etc.
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Internal Revenue Service. Retirement Topics – Exceptions to Tax on Early Distributions
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Internal Revenue Service. Retirement Topics – Plan Loans