Banner Image

2015 Voluntary Life Insurance Open Enrollment

Each year Beloit College employees may elect new Voluntary Life insurance coverage or change existing coverage during the annual enrollment period.  Highlights of the plan offered by The Hartford Insurance Company are below, along with an enrollment form and personal health application.  Your current rate information is listed on your check stub each pay period.  The bullet points below describe the different opportunities for coverage depending upon your current coverage status. 

Enrollment forms must be completed and returned by April 30

Information and rates for employees currently enrolled

Information and rates for employees not currently enrolled

Plan Highlights

Do you have questions?

The enrollment rules and the amounts that can be elected with or without proof of good health can be confusing.  If you have any questions about your current level of coverage, adding or changing coverage during this annual enrollment period, please contact the Human Resources Office at extension 2630. 


If you are currently participating in the voluntary life plan, please complete the simplified enrollment form.  If you elect to change coverage, the form must be returned to Human Resources by April 30.

  • Employees currently enrolled in coverage requesting an increase of one $10,000 increment:  If you are currently enrolled in the Voluntary Life Plan, you may increase coverage by one $10,000 increment without providing proof of good health as long as you don’t increase coverage above the $120,000 guarantee issue level of the plan.  If the requested increase is above the $120,000 guarantee issue level, you will need to provide proof of good health. 
  • Employees currently enrolled requesting an increase of more than one $10,000 increment:  You must provide proof of good health if an increase of more than one increment is requested.  To increase your coverage, please complete the simplified enrollment and a personal health application form and return it Human Resources by April 30.
  • Employees currently purchasing dependent child(ren) coverage:  The Hartford plan offers dependent child coverage in the amount of $10,000 at a rate of $1.00 per child per month.  Unless you elect to DROP coverage on your dependent children, your coverage will continue until they turn 25. Please review the definition of Dependent Child(ren) on page 27 in the Summary Plan Description booklet.  To drop the dependent care coverage, you must send written notification to the attention of Terri Dahl in Human Resources.

Simplified Enrollment Form (pdf)

Personal Health Application Form (pdf)


If you declined participation when the plan was first offered, but would like to enroll now, click below for an enrollment form and personal health application.

  • Employees not currently enrolled:  If you initially declined coverage, you are considered a late entrant to the plan and must provide proof of good health to enter the plan.  If you wish to enroll, complete the enrollment form and return it Human Resources by April 30.
  • Dependent Spouses and Children:  In order for an employee to add or increase dependent coverage, proof of good health must be provided.  Complete the enrollment form and personal health application and return to Human Resources by April 30.

Late Enrollment Form (pdf)

Personal Health Application Form (pdf)