Forms: Life

Below are forms for the Life plan. For the forms pertaining to more than one benefit plan, please refer to the Human Resources Benefits Forms Page.

Newly eligible faculty & staff may conviently elect to or waive coverage using the eBenefits , HRIS Self Service module.
Benefit Enrollment and Change ( PDF)	After hire, use this form to apply for life insurance coverage. Must attach a completed evidence of good health application
Evidence of Good Health Application (Applying for Coverage with Standard Insurance Company) ( PDF)	Use this form to apply for coverage after hire or to increase the amount of coverage. Disregard references on the form to STD or LTD. This form is strictly for Life and Dependents Life.
Beneficiary Designations ( PDF)	Please contact the Benefits Division if you wish to change beneficiary designations for the Basic or Supplemental Life insurance plans.
Coverage Withdrawal ( PDF)	Use this form to drop life insurance coverage.