State and School Employees' Life Insurance Plan Enrollment Instructions

UMMC pays 50% of the cost. You are eligible for term life based on an amount equal to two times your base annual salary-rounded to the next highest $1,000. Click here for more information, pages 27, 29.

To enroll

• Section A

  • Verify all information is accurate and complete.  Fill in missing information.

• Section B

  • Omit.

• Section C

  • Check New Enrollee box under Active Employee and enter your date of employment.

• Section D

  • Complete entire beneficiary section (2 lines per beneficiary).

• Section E

  • Print, sign and date.

To waive

• Section A

  • Verify all information is accurate and complete.  Fill in missing information.

• Section B

  • Check the Waiver of Coverage box
  • Print, sign and date in the lower right corner.