2023 Optional Life Insurance Election

Optional Life Election Form

During our recent open enrollment, the maximum amount of optional life coverage you were allowed to elect was $40,000 for yourself and $5,000 for your spouse or domestic partner. You should have had the opportunity to purchase up to $500,000 for yourself and up to $30,000 for your spouse or domestic partner. Elected amounts over $40,000 for you or $5,000 for your spouse or domestic partner are subject to evidence of insurability (EOI); you or your spouse/domestic partner must answer health questions and receive approval before the additional amounts take effect.

Using this form, you can elect a higher amount for yourself and your spouse/domestic partner. Remember that amounts above $40,000 for you and $5,000 for your spouse require EOI before the full coverage amount takes effect. You can review the biweekly costs for coverage here.

Life Insurance Insurance Form
Who Is Electing Coverage?