Louisiana State University System

Life Insurance Benefits
Enrollment

ALL FORMS MUST BE RETURNED TO YOUR
HUMAN RESOURCES DEPARTMENT.

 

New Hire
Life Insurance Benefits


Employee Benefit - New Hire
If you are a new hire, you are eligible for up to maximum 5X annual salary or $500,000 (Guaranteed Issue) whichever is less without Evidence of Insurability.
*Any other additions or increases will require Evidence of Insurability.

Spouse Benefit - New Hires or Change in Family Status
Spousal coverage available for 50% of employee's elected coverage to a maximum
of $100,000 (Guaranteed Issue) if new hire or within thirty (30) days from the date of marriage.

Child(ren) Benefit
From $5,000 - $20,000 without Evidence of Insurability.

Click Here to download and/or print the fillable, PDF enrollment application
(Please note that you must Print the completed/filled application form).
Click Here to see Rate Chart.



Continuing Employees
Life Insurance Benefits


Employee Benefit (Non New-Hire) - Guaranteed Issue (No Medical Questions)
Up to $500,000 or 5X Base Annual Salary (whichever is less)
*Additional Coverage Available up to $1,000,000 with Evidence of Insurability.

Spouse Benefit - Guaranteed Issue (No Medical Questions)
Up to 50% of employee coverage with $100,000 Limit
*Additional Coverage Available (Up to 50% of employee coverage) with approval of Evidence of Insurability.

Child(ren) Benefit - Guaranteed Issue (No Medical Questions)
From $5,000 - $20,000

Click Here to download and/or print the fillable, PDF enrollment application
(Please note that you must Print the completed/filled application form).
Click Here to see rate chart.

If you purchased at least a $10,000 policy at open enrollment, you are guaranteed an opportunity to increase your coverage at one (1) times your annual salary, each annual enrollment, without answering any medical questions.
Subject to the maximum of 5x Base Salary or $500,000 (whichever is less).

Accidental Death & Dismemberment (AD&D) Insurance
is available only if enrolling in the Life Insurance.
See Enrollment Application for details.

Added Value Benefits at No Additional Cost with
Enrollment in Life Insurance

Life Conversations ($500+ Value) Click Here for Brochure
Offers tools such as Estate Planning, Will Preparation, and Funeral Concierge Service

Beneficiary Assist ($500+ Value) Click Here for Brochure
Legal, emotional and financial support to help cope with loss of a loved one.

Employee Travel Assist Program Click Here for Brochure
Aids with pre-trip needs (passports, currency exchange rates, etc.),
emergency medical assistance and emergency personal services.

You may access the Hartford website for further information by clicking on this link
www.hartfordlifeconversations.com

LSU Life Insurance Forms


Enrollment Application
Rate Sheet (Excel)
Evidence of Insurability Application
Waiver of Premium Claim Form
Life and AD&D Claim Form
Conversion Application
Portability Application


ALL FORMS MUST BE RETURNED TO YOUR
HUMAN RESOURCES DEPARTMENT



If you have questions, please contact Insurance Management Administrators, Inc.
at 1-800-742-9944, extension 136 for assistance.