You must provide required documents/forms to complete your enrollment.

Use the Additional Forms button (above) to obtain form.

Annual Open Enrollment

· If electing new or additional coverage, you must print, complete and submit the Statement of Health (SOH) form to carrier for approval.

· Life Beneficiary Form. Return to the HR Benefits Department.

New Hire / Status Change

· Life Beneficiary Form. Return to the HR Benefits Department.

· If required, the Statement of Health (SOH) form will be mailed directly to you. Return completed Statement of Health form to carrier for approval.

For details, please refer to the Optional Life/Dependent Life Insurance Plan page in the Bi-Weekly Benefits Guide or the Physicians Benefits Guide.