Certificate of Insurance
Individual and Family Group Term Life Insurance
Policy 32871-G is a life insurance contract between Minnesota
Life and the Board of Regents of the University
of Wisconsin System. The plan is self-administered
by the University in accordance with insurance industry
See the plan brochure for detailed plan, enrollment and premium information.
See the Fact Sheet for a summary of the plan.
must be employed by the University of Wisconsin and
be eligible for coverage under the State of Wisconsin Group Health Insurance Program. Rehired annuitants receiving a Wisconsin
Retirement System benefit are not eligible for this
file an application
with your campus
benefits office within 30 days of your initial
- A second enrollment opportunity is provided for individuals eligible for graduate assistant benefits who are hired into a benefits-eligible Wisconsin Retirement System (WRS) position. To qualify for the second 30-day eligibility period, there must be no break in service of 30 days or more between the graduate assistant position and the WRS position. The 30-day period starts the date the individual becomes WRS benefits eligible.
- If you
have a spouse or domestic partner and/or dependent
child(ren) when you become eligible, the enrollment
period for spouse/domestic partner and dependent child coverage
is the same as for coverage on yourself. You may also add spouse or domestic partner coverage within 30 days of marriage or the establishment of a domestic partnership for benefits purposes.
You may add child coverage within 30 days of having an eligible child to coverage for the FIRST time.
who are unmarried and dependent on you or your spouse
or domestic partner for financial support may be insured
through the end of the year in which they reach age
is effective on the first of the month following the
date you submit your application to your campus benefits
office. If you file on the first day of the month,
coverage is effective that day.
from an approved leave of absence, temporary layoff or seasonal/academic year unpaid work break during which
coverage ended because of non-payment of premiums,
you must complete a new application within 30 days
of your return to work to reinstate coverage. You may reinstate the coverage level that you carried prior to the lapse in coverage. You may enroll your spouse/domestic
partner and children if they were insured prior to
the leave of absence.
- If you
miss your initial enrollment period, or decide later
to add more coverage, you may apply by proving good
health via an evidence
of insurability application.
you may select $5,000, $10,000, $15,000 or $20,000 of insurance
for yourself, $5,000 or $10,000 for your spouse/domestic
partner and $2,500 or $5,000 for your children.
limits of $200,000 apply for you, $100,000 for your
spouse/domestic partner and $10,000 for your children.
age and the coverage levels you select determine the
cost of insurance for yourself and your spouse/domestic
partner. Use the premium calculator or see the rate
chart to determine your monthly premium.
- The University
makes no contribution toward the premium.
are payroll deducted one month in advance.
annually increase coverage without providing any health
information. Annual limits apply.
The next AIO opportunity will be in October 2013 with increased coverage effective January 1, 2014.
Benefit up to 100% of the insurance proceeds may be
paid to you if you become terminally ill. This living benefit is also available for an insured spouse/domestic partner or child.
may be waived to age 65 should you become totally
disabled prior to turning age 60. Your payroll & benefits office will need to initiate a premium waiver by submitting a Premium Waiver Request form to UW System Administration.
- If you
die, your spouse/domestic partner and dependent child
coverage continues premium free for one year from
the date of death.
- At termination
of employment or loss of eligibility, you may convert
your coverage to a new individual life insurance
policy, without providing evidence of insurability.
You must apply to Minnesota Life within 31 days after
your group insurance coverage ends. Conversion options
are also available for an insured spouse/domestic
partner or child.
- You have the right to assign ownership of the insurance to another party. Use the Transfer of Ownership form to initiate this option.
You are encouraged
to complete a beneficiary designation
form to ensure benefits are paid to the named beneficiary.
This document was last
revised on February 7, 2013