Benefits Forms: Life Insurance Forms
IMPORTANT: All of the forms listed on these pages are in Adobe
Portable Document Format (PDF). If you do not already
have Adobe Acrobat Reader on your computer, you must download
and install Adobe
Acrobat Reader before you will be able to view
or print Benefits forms.
Group Term Life Insurance Forms
- Optional
Group Term Life Insurance Application (LE)
- University
Group Term Life Insurance Application (LE)
- Dependent
Group Term Life Insurance Application (LE)
- Beneficiary for Group Life Insurance (LC)
This form will replace any previous beneficiary information on file with the Benefits Office. Please keep a copy of this information for your records.
Health Statements
Other Group Term Life Insurance Forms
- Group Term Life Insurance Withdrawal Form (LD)
- Benefits
Enrollment/Change Form (GV)
Use this form to make changes to your benefit elections when you experience a qualified family status change. You must complete and submit this form to the HRRIS Benefits Transaction Team within 30 days after the event.
Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Benefits Office reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern. The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents.