Life Insurance Enrollment Form Code 107 PRG Sergeants
For employees in Code 107 PRG Sergeants only.
This form is used for:
- enrollment in the basic plan; and/or
- electing supplemental group life insurance; and/or
- designating beneficiaries.
Instructions
NYU provides you with $20,000 of Life and AD&D coverage at no cost to you, with a Total and Permanent Disability (T & PD) insurance benefit of $7500.
- You may purchase additional Life, AD&D and T & PD through payroll deduction. You may purchase additional coverage in increments of $5000 ranging from $5000 to $40,000.
If you wish to purchase additional coverage after your initial enrollment period expires you may do so, however, you will be required to provide the insurance carrier with proof of good health unless you apply for coverage within 31 days
of a Qualified Status Change, click here.
- You may change your beneficiary at any time.
- For more information click here
- Completed forms should be sent to the NYU Benefits Office: 7 E 12 St., 2F, New York, NY 10003 (Campus mail code: 8923).
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