Annual Open Enrollment – Additional Life Insurance

Annual Open Enrollment - Additional Life Insurance

Coverage changes will be effective on July 1 following receipt of your election.

Name

First

Last

UNID

Pursuant to the University’s Life Insurance Policy with The Standard, employees may choose to increase their current life insurance on themselves (a) by $20,000 or (b) up to the new hire Guaranteed Issue amount ($500,000 for employee), whichever is less.

To see your current enrollment, log into UBenefits and click “View My Benefits”. If you do not wish to increase your coverage, you do not need to complete this form.

I wish to increase my current employee additional life insurance coverage by $20,000 or up to $500,000, whichever is less.

I certify the following about myself:

Not a tobacco user

Uses tobacco

Electronic Signature

Date