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This form is used for enrolling in the Basic Term Life and Accidental Death & Dismemberment (AD&D) insurance plan offered by Chesapeake Public Schools through Anthem Life Insurance Company. It collects

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How to fill out Basic Term Life & AD& D Enrollment Form

01

Obtain the Basic Term Life & AD&D Enrollment Form from your HR department or online resources.

02

Read the instructions carefully to understand the requirements.

03

Fill in personal information such as your name, address, and contact details in the designated sections.

04

Provide information about your beneficiary, including their name, relationship to you, and contact information.

05

Indicate your desired coverage amount and any optional benefits you wish to enroll in.

06

Review and sign the form to confirm that all information is accurate and complete.

07

Submit the completed form to your HR department or the specified contact.

Who needs Basic Term Life & AD& D Enrollment Form?

01

Individuals who are employed and eligible for employee benefits.

02

Employees looking to secure life insurance coverage for themselves and their dependents.

03

Anyone who wants to ensure financial protection for their beneficiaries in the event of their death.

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What is Basic Term Life & AD& D Enrollment Form?

The Basic Term Life & AD&D Enrollment Form is a document used to enroll individuals in a basic term life insurance policy and Accidental Death & Dismemberment (AD&D) insurance.

Who is required to file Basic Term Life & AD& D Enrollment Form?

Typically, employees who wish to enroll in Basic Term Life and AD&D insurance offered by their employer must file this form.

How to fill out Basic Term Life & AD& D Enrollment Form?

To fill out the form, individuals must provide personal information such as name, contact details, and beneficiary information, along with any required select options regarding coverage.

What is the purpose of Basic Term Life & AD& D Enrollment Form?

The purpose of the form is to officially enroll individuals in life insurance and AD&D policies, ensuring they have financial protection in the event of death or accidental injury.

What information must be reported on Basic Term Life & AD& D Enrollment Form?

Essential information includes the participant's name, social security number, date of birth, employment details, and the designated beneficiaries' names and relationships.

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