Basic Life, AD&D, Optional Life Insurance Information
Portability and Conversion – Forms and Information
Employee Optional Life (TLF)
The TLF cap is $400,000. Your TLF coverage amount will automatically adjust January 1 based on changes to your annual salary at December 31 and your selected coverage level, up to a maximum of $400,000. Increases to your coverage level (example: from one times salary to two times salary) require Evidence of Insurability.
Spouse Optional Life (SLF)
Evidence of Insurability (EOI) applies to all coverage levels unless you are enrolling during your initial new-hire enrollment period. If you are enrolling during your initial new-hire period, EOI does not apply to the $10,000 or $25,000 SLF amount, subject to the employee’s TLF amount. Spouse coverage cannot exceed 50% of employee TLF coverage. Employee is automatically listed as the SLF beneficiary. If Evidence of Insurability (EOI) is required, coverage is subject to medical underwriting and is not effective unless approved by the carrier. Contact your Human Resources Department or Benefits Office for more information.
Dependent Group Life (DGL)
Even if you selected SLF coverage, you can select DGL coverage to cover your spouse and dependent child(ren).
Application instructions are on the back of the application form.
Always provide your employer a copy of the Application form. If Evidence of Insurability is required, mail the original Application form and Evidence of Insurability Form to Dearborn National. Important deadlines apply if you are enrolling during annual enrollment, as a newly hired employee, or as a result of a qualifying event. Instructions are on the back of the Application form.
Administration Offices, Attn: Medical Underwriting
P.O. Box 655403
Dallas, TX 75266-5403