I want to enroll or change voluntary accidental death and dismemberment insurance:


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  • Access the Life Insurance Enrollment Form, and complete the “Personal Information,” “Voluntary Accidental Death and Dismemberment Insurance,” and “Beneficiary” sections.
  • May enroll during New Hire period (within 30 days of hire date).
  • May enroll during Annual Enrollment period or a qualifying event.
  • Send the form to Human Resources by e-mail, fax, or intercampus mail.



If you also want to enroll or change voluntary life insurance and/or voluntary dependent life insurance, you may complete additional sections on the Life Insurance Enrollment Form.