UW Benefits Forms and Publications
Term Life/Accidental Death & Disability Insurance

At any time, you may enroll or make changes to your life insurance. Download this form:

• 2013 Life & Accidental Death & Dismemberment (AD&D) Insurance Enrollment/Change Form (PDF)
  

In addition, submit the 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.

Download and complete the appropriate EOI form:

• 2013 Life Insurance Evidence of Insurability

To apply for non-tobacco user rates on your life insurance, download the Non-Smoker Certification form (PDF).

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.

• Download the 2013 Plan Book (PDF).

• Employee Self Service (ESS)