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.



Non New-Hire Employees
Life Insurance Benefits


Employee Benefit (Non New-Hire)
Coverage is available from $10,000.00 - $1,000,000 with Evidence of Insurability.

Spouse Benefit
Spouse Coverage is available (Up to 50% of employee coverage $5,000 - $250,000) with approval of Evidence of Insurability.

Child(ren) Benefit
Child(ren) Coverage is available in increments of $5,000/$10,000/$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.
Click Here to see Evidence of Insurability application.

If you are currently enrolled in Hartford Life, 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 FORMS (PDF)
Enrollment Application
Evidence of Insurability Application

RATE SHEET (XLS)
Rate Sheet (Excel)

CERTIFICATE OF INSURANCE (PDF)
Certificate of Insurance

ADDITIONAL FORMS (PDF)
Waiver of Premium Claim Form
Life and AD&D Claim Form
Conversion Application
Portability Application
Change of Beneficiary Form

BROCHURES (PDF)
Life Conversations
Beneficiary Assist
Employee Travel Assist Program


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.


* Guaranteed issue is only available to employees/spouses/children if they are "actively at work/life" as per the effective date life insurance policy provisions. If an employee/spouse/child is not "actively at life/work or is confined elsewhere", the actual effective date of the policy is determined by The Hartford as outlined in the policy deferred effective date provision.

Underwritten by Hartford Life And Accident Insurance Company. The Hartford® is The Hartford Financial Services Group, Inc. and its subsidiaries, including issuing companies Hartford Life Insurance Company and Hartford Life and Accident Insurance Company. Policies sold in New York are underwritten by Hartford Life Insurance Company. Home Office of both companies: Simsbury, CT. All benefits are subject to the terms and conditions of the policy. Policies underwritten by the issuing companies listed above detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.