Insurance Forms

For newly hired employees (within 30 days of hire date), a majority of your insurance elections will be made in Workday. There are few forms with a necessary hard copy.

If the Pelican HSA plan is selected, please complete the HSA Application (GB-79) form at right.

For current employees, Evidence of Insurability forms may need to be completed, if electing to enroll in any life insurance plan outside of the initial 30-day new-hire window. For the Voluntary Life Insurance, Long-Term Disability, Accident Protection and Critical Illness plans, use the UHC Standard EOI Form at right.

For Long-Term Care Insurance enrollment, use the UNUM Long Term Care EOI form at right.

10/3/2017 3:15:24 PM
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