Benefits - By Plan

 

 

For Health Savings Account (HSA):

 

Complete and submit to EPIC Life Insurance Company to name who you would like to receive benefits payable upon your death under the Accidental Death and Dismemberment provision.

 

Complete and submit to EPIC Life Insurance Company to file a claim for an outpatient surgery or hospital confinement.

Complete and submit to Davis Vision to file a claim for vision services received out of the Davis Vision network.

 

 

Complete and submit to EPIC Life Insurance Company to file a claim for a death or dismemberment.

 

 

 

 

 

 

Complete and submit to your institution’s benefits office to enroll in the plan.

 

 

Complete and submit to the Department of Employee Trust Funds (ETF) to name who you would like to receive benefits payable upon your death.

 

 

If you are terminally ill with a life expectancy of 12 months or less, read the Living Benefits Brochure to determine if you’d like to apply for living benefits.

 

 

Complete and submit to Minnesota Life if you want to convert your coverage to an individual policy at the end of employment. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

 

 

Complete and submit to Minnesota Life if you want to apply for coverage through Evidence of Insurability. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

 

 

  • Continuation Form – Contact your benefits office if you need a continuation form. Continuation at retirement is automatic.

 

  • Accelerated Death Benefit Form
    Accelerated Death Benefit Form

    Complete and submit to Minnesota Life if you have a terminal illness with a life expectancy of less than 12 months and want to apply for benefits payable during your lifetime. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

  • Conversion Form
    Conversion Form

    Complete and submit to Minnesota Life if you want to convert your coverage to an individual policy at end of employment. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

  • Medical Evidence of Insurability Form
    Medical Evidence of Insurability Form

    Complete and submit to Minnesota Life if you want to apply for coverage through Evidence of Insurability. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

  • Beneficiary Designation
    Beneficiary Designation

    Complete and submit to UW System Administration to name who you would like to receive benefits payable upon your death.

Plan Administration

The Individual and Family Group Life Insurance plan (group policy #32871-G) is administered by University of Wisconsin System Administration and underwritten by Minnesota Life Insurance.

  • Accelerated Death Benefit Form
    Accelerated Death Benefit Form

    Complete and submit to Minnesota Life if you have a terminal illness with a life expectancy of less than 12 months and want to apply for benefits payable during your lifetime. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

  • Conversion Application
    Conversion Application

    Complete and submit to Minnesota Life if you want to convert your coverage to an individual policy at the end of employment. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

  • Medical Evidence of Insurability Form
    Medical Evidence of Insurability Form

    Complete and submit to Minnesota Life if you want to apply for coverage through Evidence of Insurability. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

 

Plan Administration

The UW Employees, Inc. Life Insurance Plan (group policy #33977-G) is administered by University of Wisconsin Employees Inc., an employee-directed nonprofit corporation. Minnesota Life Insurance is the underwriter for this plan.

  • Beneficiary Designation
    Beneficiary Designation

    Complete and submit to Minnesota Life to name who you would like to receive benefits payable upon your death.

  • Accelerated Benefit Form
    Accelerated Benefit Form

    Complete and submit to Minnesota Life if you have a terminal illness with a life expectancy of less than 12 months and want to apply for benefits payable during your lifetime.

  • Conversion Form
    Conversion Form

    Complete and submit to Minnesota Life if you want to convert your coverage. Your benefits office must complete the Employer Section before it is submitted to Minnesota Life.

 

Plan Administration

The University Insurance Association Life Insurance Plan (group policy #32872-G) is administered by the University Insurance Association Board. The plan is underwritten by the Minnesota Life Insurance Company.

  • Application
    Application

    Complete and submit to your institution's benefits office to enroll in the plan.

  • Beneficiary Designation
    Beneficiary Designation

    Complete and submit to UW System Administration to name who you would like to receive benefits payable upon your death.

  • Conversion Form
    Conversion Form

    Follow the instructions on the conversion bulletin to learn how to convert your group policy to an individual policy. Must be under age 70 to convert.

 

Plan Administration

The Accidental Death and Dismemberment Insurance plan (group policy #GTU 8364005) is administered by University of Wisconsin System Administration and Hausmann-Johnson Insurance and underwritten by Zurich American Insurance Company.

 

 

 

 

 

 

  • Application
    Application

    Complete and submit to your institution's benefits office to enroll in this plan.

Complete and submit to ETF if you want to apply for coverage or decrease your waiting period through Evidence of Insurability. Your benefits office must complete the Employer Section before it is submitted to ETF.

  • Sick Leave Usage During Disability Claim (UWS 430)
    Sick Leave Usage During Disability Claim (UWS 430)

    Complete this form only if you are applying for a WRS Disability annuity (40.63), a Long-Term Disability Insurance (LTDI) benefit or a Duty Disability benefit at the same time you are applying for an ICI benefit.

 

See Also