Benefits - By Plan

 
  • Application – Complete and submit to your institution’s benefits office to enroll in the plan.  Watch ETF’s presentation on how to properly complete each section of the application.
  • Affidavit for Insurance Purposes (UWS 93) – Complete and submit with your health insurance application if your covered family member is not a United States citizen and does not have a Social Security number.
  • Application – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Application – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Beneficiary Designation – Complete and submit to Department of Employee Trust Funds (ETF) to name who you would like to receive benefits payable upon your death.
  • Living Benefit Brochure – 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.
  • 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 – 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.

Plan Administration

The State Group Life Insurance plan is administered by the Department of Employee Trust Funds (ETF) and is underwritten by Minnesota Life Insurance.

  • Application – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Beneficiary Designation – Complete and submit to UW System Administration to name who you would like to receive benefits payable upon your death.
  • 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 – 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 – 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 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.

  • Application – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Beneficiary Designation – Complete and submit to Minnesota Life to name who you would like to receive benefits payable upon your death.
  • 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 – 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 – 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 – Complete and submit to Minnesota Life to name who you would like to receive benefits payable upon your death.
  • 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 – 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.
  • Continuation Form – Contact your benefits office if you need a continuation form.

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 – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Beneficiary Designation – Complete and submit to UW System Administration to name who you would like to receive benefits payable upon your death.
  • 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.
  • Continuation Form – Contact your benefits office if you need a continuation form.

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 – Complete and submit to your institution’s benefits office to enroll in the plan.
  • Medical Evidence of Insurability – 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) – 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