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Plan design
Documents
- Basic group life insurance (pdf)
- An overview of the basic life coverage for VRS members
- Optional group life insurance (pdf)
- An overview of the optional life coverage options for VRS members
- Optional life premium calculation worksheet - existing insured (xls)
- See how affordable optional life coverage can be using the common date
- Optional life premium calculation worksheet - new participant (xls)
- See how affordable optional life coverage can be using the applicant's current age
- Optional life premium calculation worksheet- retiree continuation (xls)
- Retirees have the option to continue a "portion" of their optional life insurance coverage within the group plan. See the cost if continuing in the group plan. Applicants coverage is subject to a reduction schedule.
- Certificate of insurance (pdf)
- Distribute to each insured employee
- Conversion brochure (pdf)
- (VRS-35) Enrollment information and form for conversion of group life insurance
Enrollment
Forms
- Enrollment application for VRS optional group life insurance (pdf)
- (VRS-39) Required to sign up for optional term coverage
- Group life evidence of insurability (pdf)
- (VRS-32) Complete to be underwritten for coverage that is not guaranteed
Administration
Forms
- Request for change under optional group life insurance plan (pdf)
- (VRS-39a) Required to make changes to your optional term coverage
- Retiree optional life continuation (pdf)
- (VRS-39R) For retirees who want to continue optional term coverage
- Beneficiary Change
- VRS members and retirees can update beneficiaries online through their secure myVRS account
- Absolute assignment of group life insurance (pdf)
- (VRS-37) Required to transfer ownership of your VRS life insurance policy
- Assignee's change of beneficiary (pdf)
- (VRS-38) Required when the new policy owner wishes to change the beneficiary
Claims
Documents
- Notice of claim (pdf, 08/31/2022)
- Required for all claims
- Beneficiary statement (pdf, 04/28/2021)
- Required for designated beneficiary(ies)
- Preference beneficiary statement (pdf, 04/28/2021)
- Required when no beneficiary was designated
- Notice of accidental loss - claimant statement (pdf, 01/01/2019)
- (VRS-31) Required to claim this benefit
- Notice of accidental loss - attending physician statement (pdf, 01/01/2019)
- (VRS-31) Required to claim this benefit
- Notice of accelerated benefit - claimant statement (pdf, 01/01/2019)
- Required to claim accelerated benefits
- Notice of accelerated benefit - attending physician statement (pdf, 01/01/2019)
- Required to claim accelerated benefits
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