Enrollment Form for Life Insurance

This is the form employees need to complete to enroll in Optional Term Life Insurance for the first time or to increase their already existing coverage by MORE than $50,000.  (Please complete part I and II.)

1. Part I - Life Insurance Enrollment Form  (pdf)
2. Part II - Evidence of Insurability  (pdf)

    Group Term Life/Accidental Death and Dismemberment Insurance

(District paid-for benefit is $12,000 term life and AD&D.  May purchase more coverage through payroll deduction.)

1. Information  (pdf)

2. Confidentiality and Disclosure Statement  (pdf)

3. Beneficiary Change Form  (pdf)

4. Group Term Life and Voluntary AD&D Plan Document  (pdf)

    Phone Numbers

Fort Dearborn Term Life & Voluntary Accident Insurance
1-800-778-2281 (press 1 for Group Insurance)11-05-08