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If you already have supplemental life insurance through the PEBB Program
If you or your spouse or state-registered domestic partner
currently have PEBB supplemental life insurance (formerly Part B
Supplemental, Part C Optional, and/or Part D Supplemental) and have not
been declined for PEBB supplemental life insurance in the past, you may
apply for higher amounts of supplemental life insurance without medical
review as shown below. If you have been declined PEBB supplemental life
insurance coverage in the past, you can still apply for additional
coverage, but you must provide evidence of insurability and be approved
by ReliaStar Life. The PEBB Programs special reenrollment opportunity
runs February 1 - March 31, 2012.
| If you are: |
You can apply for up to this amount of Supplemental Life Insurance with guaranteed issue |
Or up to this amount of Supplemental Life Insurance by providing evidence of insurability |
| Employee under age 60 |
$50,000 not to exceed $250,000 total |
$750,000 |
| Employee age 60 or older |
$50,000 not to exceed $100,000 total |
$750,000 |
| Spouse or state-registered domestic partner of employee |
$25,000 up to $50,000 total (not to exceed 50% of your Employee Supplemental Life Insurance amount) |
50% of Employee Supplemental Life Insurance amount |
If you don't have supplemental life insurance through the PEBB Program
If you or your spouse or state-registered domestic partner
do not currently have PEBB supplemental life insurance, you may also
apply for higher amounts of supplemental life insurance (with evidence
of insurability). Your coverage starts the first day of the month after
ReliaStar Life approves your application.
Regardless
of the life stage you are in, life insurance can help protect you and
those you love from the unexpected, and preserve what you value most.
Life insurance is an important part of your overall benefits package, and taking advantage of
supplemental group insurance coverage can be an important part of your financial security.
To enroll, follow these steps:
- Verify your current coverage amounts by reviewing your annual Statement of Insurance or
going to your employer's online employee portal.
- Review the Enrollment At A Glance. It describes your coverage options and monthly costs.
You can find more details on your life insurance benefits for 2012 in the Certificate of
Coverage.
- If you need help determining the amount of coverage your family needs, consider using the Life
Insurance Calculators. There are two calculators available:
- The PDF Life Insurance Calculator is a quick and easy way to help you determine the
coverage you need to meet your family's goals.
- The Online Life Insurance Calculator goes into more detail about how to determine the
coverage amounts you need to meet your family's goals.
- Complete, print, and sign the appropriate form(s) and submit them as follows:
| If you: |
Complete these form(s) |
During this timeframe |
Coverage
effective date |
| Currently have PEBB supplemental life insurance, and
wish to apply for up to $50,000 more up to $250,000 total (if
under age 60) or up to $100,000 total (if age 60 or older) |
Life and AD&D Insurance
Special Reenrollment Form
(submit to your personnel,
payroll or benefits office) |
February 1 - March 31, 2012 |
The first day of the month following application* |
| Currently have PEBB supplemental
life insurance, and wish to apply for more than $50,000
or above $250,000 total (if under age 60) or
above $100,000 total (if age 60 or older) up
to $750,000 total |
From February 1 - March 31, 2012:
Life and AD&D Insurance Special Reenrollment Form
(submit to your personnel, payroll, or benefits office)
Starting April 1, 2012:
Life and AD&D Insurance Enrollment/Change Form
(submit to your personnel, payroll, or benefits office)
Life Insurance Evidence of Insurability Form
(submit to ReliaStar Life) |
February 1, 2012 or later |
The first day of the month after ReliaStar Life approves your application. |
| Currently have PEBB supplemental life insurance for
your spouse/state-registered domestic
partner, and wish to apply for up to $25,000 more (up to $50,000
total), not to exceed 50% of your Employee Supplemental Life Insurance
amount |
Life and AD&D Insurance
Special Reenrollment Form
(submit to your personnel,
payroll or benefits office) |
February 1 - March 31, 2012 |
The first day of the month following application* |
| Currently have
PEBB supplemental
life insurance for your spouse/state-registered
domestic partner, and wish to apply for more than
$25,000 (or any amount over $50,000 total), not to exceed 50% of your Employee Supplemental Life Insurance amount |
From February 1 - March 31, 2012:
Life and AD&D Insurance Special Reenrollment Form
(submit to your personnel, payroll, or benefits office)
Starting April 1, 2012:
Life and AD&D Insurance Enrollment/Change Form
(submit to your personnel, payroll, or benefits office)
Life Insurance Evidence of Insurability Form
(submit to ReliaStar Life) |
February 1, 2012 or later |
The first day of the month after ReliaStar Life approves your application. |
Do not currently have PEBB
supplemental life insurance as an employee or for
your spouse/state-registered domestic
partner (and are not initially eligible for
PEBB benefits), and wish to apply
Note: If you apply for supplemental life
insurance for your spouse or state-registered domestic partner, you must
also enroll in Employee Supplemental Life Insurance and
Spouse/State-Registered Domestic Partner Basic Life Insurance |
From February 1 - March 31, 2012:
Life and AD&D Insurance Special Reenrollment Form
(submit to your personnel, payroll, or benefits office)
Starting April 1, 2012:
Life and AD&D Insurance Enrollment/Change Form
(submit to your personnel, payroll, or benefits office)
Life Insurance Evidence of Insurability Form
(submit to ReliaStar Life) |
February 1, 2012 or later |
The first day of the month after ReliaStar Life approves your application. |
| *If you or your
spouse/state-registered domestic partner has been previously declined
for supplemental life insurance by ReliaStar Life, you must also submit a
Life Insurance Evidence of Insurability Form. ReliaStar Life must
approve the application before coverage will begin. |
Enrollment at a Glance
|
|
Learn more about your coverage options and rates. |
|
| |
PDF Life Insurance Calculator
|
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Quickly find out how much life insurance you need to reach your goals. |
|
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Online Life Insurance Calculator
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For a more in-depth look at how much life insurance you need to reach your goals. |
|
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Special Reenrollment Form
|
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To enroll in or apply for higher coverage amounts from February 1 - March 31, 2012. Complete, print, and sign the form. |
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Evidence of Insurability Form
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If applicable, please complete the Evidence of Insurability form. |
|
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Certificate of Coverage
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For details on your life insurance benefits for 2012. |
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These calculators are
for educational purposes only - you may want to consult a financial
advisor before making final decisions. You may not be able to apply for
all coverage through your benefit plan. |
