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Life Insurance

Your employer provides, at no cost to you, Basic Life and AD&D (Accidental Death and Dismemberment) Insurance in an amount equal to 1 times your annual Earnings, rounded to the next higher $1,000, to a maximum of $50,000.

You can, at your own cost, also purchase additional life insurance. This is called Supplemental Life Insurance.

Supplemental Life Insurance amounts can be purchased as follows:
For yourself - $25,000 to  a maximum of $300,000
For your spouse - 1/2 of the Supplemental amount you chose for yourself to a maximum of $150,000
For your child(ren) - $10,000 for each child**

You are eligible for Basic Life Insurance and Supplemental Life insurance if you are an active part-time or full time employee who works at least 20 hours per week on a regularly scheduled basis.

Life Insurance pays your beneficiary a benefit if you die while you are covered.

""NOTE: If you currently have Supplemental LIfe Insurance on yourself, and you want to add life insurance on your child(ren), you do not need to complete the Personal Health Application Form. That form is only if you are purchasing Supplemental Life insurance on yourself or your spouse.

 

INFORMATION FORMS
  • Enrollment Form New Employees
    Complete this form if you are a new part-time or full time employee working at least 20 hours per week and want to purchase Supplemental Life Insurance.

    If you are applying for more than the guaranteed amount of $150,000 for yourself and/or $20,000 for your spouse, you must also complete the Health Application Form.
     
  • Change of Status Form
    Complete this form if you are a current employee and want to change your Supplemental life insurance election due to a qualifying event such as a new child; marriage; divorce; death of dependent, etc. Must be done within 31 days of Status Change Date. 

    If you are applying for more than the guaranteed amount of $150,000 for yourself and/or $20,000 for your spouse, you must also complete the Health Application Form.
     
  • Beneficiary Designation Form
    Use this form if you want to change your beneficiaries for your basic life and/or supplemental life insurance.
     
  • Request To Decrease Supplemental Life Insurance
    If you want to decrease the Supplemental Life Insurance you currently have on yourself or your spouse, complete this form.
     
  • Cancelation Form
    If you want to cancel the Supplemental Life insurance you currently have on yourself, your spouse or child (ren) , complete this form.

 

 

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