Individual and Family Group Term Life Insurance

  1. Overview
  2. Publications
  3. Forms

Plan Overview

Description: The plan provides group term life insurance. Initially, you may select up to $20,000 of coverage for yourself, up to $10,000 for a spouse/domestic partner, and up to $2,500 per child. Maximum employee coverage for 2015 is $300,000, $150,000 for a spouse/domestic partner, and $25,000 per child. Annually, participants have an opportunity to increase coverage without evidence of insurability.

Premiums

Individual and Family Group Life Insurance Premiums

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More Information

Conversion Information

Vendor

Securian Financial Group

Send questions to: benefits@ohr.wisc.edu

Forms

Note: Use Adobe Reader to open and complete PDF forms.
MAC Users: Do not use "Preview," a PDF reader.

Application | Submit to your Payroll & Benefits Office

Application / Cancellation / Change Request, UWS 1301

Evidence of Insurability | Submit to Securian Financial Group

Evidence of Insurability, 03-30538
If you do not enroll for coverage when you are first eligible or would like to increase your coverage beyond the annual increase option amount, you can apply by completing an Evidence of Insurability application.

Beneficiary Designation | Submit to UW System Administration

Beneficiary Designation, UWS 1305

Transfer of Ownership | Submit to Securian Financial Group

Transfer of Ownership, F66318-2

Accelerated Benefit

Notice of Claim for Accelerated Benefit