How do I enroll in or make changes to my life insurance coverage?

Supplemental Life Insurance

If you did not enroll in Supplemental Life Insurance when you were first eligible for benefits, there are other opportunities to enroll without proof of good health. 

  • Marriage or establishing a Domestic Partnership
  • Birth or adoption of a child, or date a stepchild, grandchild or legal ward meets UC requirements
  • Involuntary loss of other UC-sponsored life insurance

These events create a new Period of Initial Eligibility (PIE) to enroll.  The PIE begins on the date of the qualifying event and ends 31 calendar-days later, or the last business day of that 31 day period if earlier.  If you are already enrolled in the Supplement Life Insurance plan, these life events also provide a new PIE to increase your coverage amount.

See the Family Changes Benefits Checklist for complete details on enrollment criteria & deadlines.

To enroll at any other time, you may apply through the Statement of Health process (see below).  Your application is subject to review by the insurance carrier and may be approved or denied.

Enroll in or increase your coverage during a new Period of Initial Eligibility (PIE):

Complete a UPAY 850 form and submit it to the Benefits Office by email or fax (209-228-8586)

  • Section 1: complete all requested information
  • Section 2: check "Other" box and write event description and event date under Comments
  • Section 4 Supplemental Life: check appropriate action box and check box for new coverage amount
  • Sign and date form at the bottom

Decrease existing coverage (may be done at any time):

Complete a UPAY 850 form and submit it to the Benefits Office by email or fax (209-228-8586)

  • Section 1: complete all requested information
  • Section 2: write "Decrease life insurance coverage" in Comments
  • Section 4 Supplemental Life: check "Change" action box, and check box for desired coverage amount
  • Sign and date form at the bottom

Cancel existing coverage (may be done at any time):

Complete a UPAY 850 form and submit it to the Benefits Office by email or fax (209-228-8586)

  • Section 1: complete all requested information
  • Section 2: check the cancel coverage box
  • Section 4: check the Cancel box under the Supplemental and/or Dependent Life plan as appropriate
  • Sign and date form at the bottom

Dependent Life Insurance

If you did not enroll in Dependent Life Insurance when you were first eligible for benefits, there may be other opportunities to enroll without proof of good health. You have a 31 day PIE to enroll from the date of the qualifying event:

  • Marriage or establishing a Domestic Partnership
  • Birth or adoption of a child, or date a stepchild, grandchild or legal ward meets UC requirements
  • Involuntary loss of other UC-sponsored life insurance

Restrictions may apply if the newly eligible spouse or domestic partner is not the first eligible family member.  If that is the case, please contact the Benefits Office for more information.

To enroll a spouse or domestic partner at any other time, you may apply through the Statement of Health process (see below).  The application is subject to review by the insurance carrier and may be approved or denied.

Dependent children may be enrolled at any time. No Statement of Health is required even if the PIE has expired. 

Enroll in Dependent Life during a new Period of Initial Eligibility (PIE):

Complete a UPAY 850 form and submit it to the Benefits Office by email or fax (209-228-8586)

  • Section 1: complete all requested information
  • Section 2: check "Other" box and write event description and event date under Comments
  • Section 4 Dependent Life: check appropriate action box and check box for new coverage type
  • Sign and date form at the bottom

Statement of Health (SOH) Process for Life Insurance
To initiate the SOH process, complete a UPAY 850 and submit it to the Benefits Office.

  • Section 1: complete all requested information
  • Section 2: check Statement of Health box.
  • Section 4: Check appropriate boxes for Supplemental and/or Dependent life, including coverage amount
  • Sign and date form at the bottom

Upon receipt of the completed UPAY 850 form, the Benefits Office will send you an Evidence of Insurability form for you to complete and submit directly to the life insurance carrier. After completing their review (generally 4-6 weeks) the carrier will notify you and the Benefits Office of their decision.  If your request is approved, the Benefits Office will process the enrollment/change upon receipt of the carrier approval.