Depending on when you enroll in life insurance and the amount of coverage, you may be
required to submit a health statement as proof of your insurability.
Your coverage becomes effective when the health statement is approved, the
Benefits Office has been notified, and you are actively at work. You need only submit
a health statement for your initial enrollment. You do not need to resubmit a health
statement for continuation of coverage.
Insurance Coverage for You
If you enroll in life insurance within 30 days of the date you become eligible and
choose less than $500,000 of coverage, you will not need to provide a satisfactory
health statement as proof of insurability. Therefore, it is to your advantage to
enroll in life insurance at the time you become eligible, either when you are a
new faculty or staff member at the University or when you become newly eligible
for this benefit as the result of a change in appointment.
In all other cases, you will need to furnish evidence of insurability that is
satisfactory to the MetLife. MetLife may
also require a physical examination.
Proof of good health consists of either a short form health statement or
a long form health statement. The type of statement you need depends on the
amount of coverage you purchase. You may enroll in the University Plan first
and then add the Optional Plan at a later date. You would need to complete a
long form health statement.
Insurance Coverage for Your Dependents
Your spouse or other qualified adult will need to provide satisfactory
evidence of insurability in order to enroll in the Dependent Life Insurance Plan.
Dependent children do not need to submit a health statement.
Health Statement Forms
The short form and long form health statements are available for download from the
Life Insurance Forms page or by request from the HR/Payroll Service Center.
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Health Statement Needed
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Coverage Choices
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Short Form
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Long Form
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If you elect the University Plan
and you were not automatically enrolled as a new hire
(hire date after January 1, 2001) and have not previously
enrolled in the University Plan1
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X
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You elect the University Plan after the 30-day new hire or newly eligible eligibility
deadline is over |
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X
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You elect Optional Life Insurance coverage and the amount
of coverage is over $500,000
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X
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You enroll in or increase your Optional coverage to less
than $500,0001
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X
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Dependent Spouse or OQA1
$10,000
$25,000
$50,000
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X
X
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X
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Dependent Children from age 15 days to the end of the calendar year
in which the child turns 25
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NA2
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NA2
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1 A long form health statement may be required if you do
not successfully pass the short form.
2 No health statement is required for children.
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