Eastern Michigan offers employees Basic Life and Accidental Death & Disability to you at no cost. Eastern also offers the chance to purchase voluntary supplemental insurance. You can elect coverage for yourself, spouse or additional eligible adult and/or dependent children. If you're applying for supplemental life insurance, you'll need to complete the evidence of insurability form for each applicant. The statement of health must be submitted to the insurance carrier (The Hartford) . Your coverage will be determined by the Hartford and approval is not guaranteed.
- CP, PS, PE/PT Basic Life, AD&D, Supplemental Life , Dependent Life, AD&D Plan Booklet [PDF]
- CP, PS, PE/PT Basic Life Amendatory Rider [PDF]
- FA, AP, AH,AC, CA Basic Life, AD&D, Supplemental Life , Dependent Life, AD&D Plan Booklet [PDF]
- FA, AP, AH, AC, CA Basic Life Amendatory Rider [PDF]
- FM, CS Basic Life, AD&D, Supplemental Life , Dependent Life, AD&D Plan Booklet [PDF]
- FM, CS Basic Life Amendatory Rider [PDF]
- LE Basic Life, AD&D, Supplemental Life , Dependent Life, AD&D Plan Booklet [PDF]
- LE Basic Life Amendatory Rider [PDF]
- Hartford Beneficiary Designation Form [PDF]
Supplemental Life - Dependents
It is your responsibility to know and enroll dependents properly. All decisions are made and maintained by the Hartford.
Dependents means: Your Spouse and Your Dependent Child(ren). A dependent must be a citizen or legal resident of the United States of America, Puerto Rico, Guam and any other locations where the Hartford may legally provide such coverage.
Dependent Child(ren) means:
Your unmarried children, stepchildren, legally adopted children, foster children, or any other children related to You by blood or marriage or domestic partnership who:
- live with You in a regular parent-child relationship; and/or
- You claimed as a dependent on Your last filed federal income tax return; provided such children are primarily dependent upon You for financial support and maintenance and are:
- at least 15 days old but not yet age 19;
- age 19, but not yet age 23, and in full-time attendance (at least 12 course credit hours per semester) at an accredited institution of learning. If the institution establishes full-time status in any other manner, the Hartford reserves the right to determine whether the student continues to qualify as a Dependent; or
- age 19 or older and disabled. Such children must have become disabled before attaining age 19. You must submit proof of such children's disability.
Porting and Converting
When you leave EMU you have the ability to move your EMU policy(s) over to an individual policy(s) by completing the form included below. The policy numbers are found in the above attachments for the policy you have.