The District automatically provides basic life insurance
1 x your annual salary or $50,000 (whichever is greater)
Group Policy #681933
Certificate of Insurance
(for Basic, Supplemental & Dependent Life Insurance Coverage)
As a new hire you can select, up to 5 times your annual earnings ($500,000 maximum). Amounts elected in excess of $250,000 will require a Statement of Health. Your spouse can apply for amounts equal to 100% of the employee's coverage up to $100,000. Spouse life insurance elected in excess of $40,000 will require a
Statement of Health.
Unmarried children from 14 days old to age 26 are eligible for up to $10,000 of life insurance.
Each year during Open Enrollment established policies can be increased by $10,000 for participating employees and their spouse . A Statement of Health will be required for any increase over $10,000. Once coverage reaches $250,000 for an employee all increases will be subject to a Statement of Health. Once spouse coverage reaches $40,000 all increases will be subject to a Statement of Health.
Active employees not previously enrolled can select supplemental, spouse & child life each year during Open Enrollment . This enrollment will require a Statement of Health.
Premiums are paid on an after-tax basis through payroll deductions. This policy has a portability option allowing employee coverage to continue after termination of employment.
*New RSCCD Conversion_Portability Form
Designation of Beneficiary Form
Employee Beneficiary Designation
- Complete the form and mail to Diane Loya, Employee Benefits Office, 2nd Floor Ste. 225, RSCCD District Office. Please note, this form does not automatically update other beneficiary information with non-Hartford voluntary life insurance plans, RSCCD HR Dept. or pension providers. Please contact the appropriate provider for assistance.
Complete a Statement of Health for yourself and each family member you wish to insure. Mail the Statement of Health to The Hartford:
Hartford Life And Accident Insurance Company
Statement of Health Unit
One Hartford Plaza
Hartford, CT 06155