UW Benefits Forms and Publications
Term Life/Accidental Death & Disability Insurance Forms
- This page contains a list of life and accidental death and dismemberment (AD&D) forms and publications. Navigate the right side bar to find forms and publications specific to other areas of interest.
- Unless otherwise noted on the form, please send completed documents to the UW Benefits Office, Box 359556. (We cannot accept enrollment forms sent by fax or email attachment.)
- If you prefer to hand-deliver documents or send them through U.S. mail, read these directions.
- Read the form carefully to see whether additional documentation is required.
- Be sure to make copies of documents for your records before submitting them as we cannot make copies for you.
- If you cannot find a form or publication on this page or through one of the links shown at right, contact email@example.com. One of our support team will respond to your request within 2-3 business days.
|Life & AD&D Insurance Enrollment/Changes
At any time, you may enroll or make changes to your life insurance. Download and complete this form:
In addition, you must submit an Evidence of Insurability (EOI) form if you are:
- a newly-eligible employee who applies after the initial 60-day deadline for guarantee-issue coverage, OR
- a PEBB insurance-eligible employee who applies for more insurance than is guarantee-issue, OR
- a PEBB insurance-eligible employee who wants to increase coverage amounts at a later date.
To apply for non-tobacco user rates on your life insurance:
|Beneficiary Designation Change Request
||Voya Financial's Beneficiary Designation Request form.
|Group Life Insurance Conversion or Portability
Conversion: Within 60 days of your or your dependents' coverage termination date, you may apply to convert your group term life insurance to individual whole life insurance.To receive information regarding Conversion Rights, check the Conversion Box on page two of the Group Life Portability Application Form. ReliaStar Life Insurance Company will send you a description of the conversion plan, premiums rates, and an application form. Separating or retiring employees may also contact the Benefits Office for information.
Portability: To apply for life insurance portability, contact the Benefits Office within 31 days of your or your dependents' coverage termination date.
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Life Insurance Publications/Resources
Contact us if you cannot find a form or publication on this page or through one of the links shown at right. To report a web problems, firstname.lastname@example.org.