| Newly-Eligible Employees:
Apply for Guaranteed Issue Amounts |
Newly-eligible employees must use this form to apply for "guarantee" issue amounts (amounts not requiring evidence of insurability). |
|---|---|
| Current Employees:
Remove coverage, or apply for basic dependent life insurance or AD&D Insurance |
Current enrollees may use this form to remove coverage, apply for basic dependent or accidental death and dismemberment (AD&D) insurance. |
| Current Employees: Obtain or Increase Optional Supplemental Life Insurance |
|
| Non-Smoker Certification | To apply for non-tobacco user rates on your life insurance, download the Non-Smoker Certification form (PDF). |
| Beneficiary Designation Change Request | Download the ING form (PDF). |
| Group Life Insurance Portability or Conversion | For Portability: Within 31 days of your or your dependents' coverage termination date, apply for life insurance portability. Download the 2012 Portability form (PDF). For 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. |
| Return to top of page |
|
| Life Insurance Enrollment Plan Book | |
|---|---|
| Address Updates | |
| Return to top of page |
|
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, contact benefits@uw.edu.
FORMS & PUBLICATIONS
