Form preview

Get the free ENROLLMENT FORM – EMPLOYEE BASIC LIFE & AD&D and GROUP SUPPLEMENTAL TERM LIFE INSURANCE

Get Form
This document is an enrollment form for employees of the Roman Catholic Archdiocese of Atlanta to apply for basic and supplemental life insurance coverage, including specifics on coverage amounts
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign enrollment form employee basic

Edit
Edit your enrollment form employee basic form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your enrollment form employee basic form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit enrollment form employee basic online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Follow the steps down below to benefit from the PDF editor's expertise:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Upload a document. Select Add New on your Dashboard and transfer a file into the system in one of the following ways: by uploading it from your device or importing from the cloud, web, or internal mail. Then, click Start editing.
3
Edit enrollment form employee basic. Rearrange and rotate pages, add new and changed texts, add new objects, and use other useful tools. When you're done, click Done. You can use the Documents tab to merge, split, lock, or unlock your files.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
With pdfFiller, it's always easy to work with documents. Try it out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out enrollment form employee basic

Illustration

How to fill out ENROLLMENT FORM – EMPLOYEE BASIC LIFE & AD&D and GROUP SUPPLEMENTAL TERM LIFE INSURANCE

01
Start by obtaining the ENROLLMENT FORM from your HR department or company website.
02
Fill in your personal information at the top, including your full name, employee ID, and contact details.
03
Specify your date of birth and any other required identification information.
04
Review the section on basic life and AD&D coverage options and select the amounts of coverage you wish to enroll in.
05
Fill out any beneficiary information, ensuring that you have the full name and relationship of the person you're designating.
06
Move on to the Group Supplemental Term Life Insurance section and choose the coverage that suits your needs.
07
Sign and date the form to confirm that all information provided is accurate.
08
Submit the completed form to your HR department by the specified deadline.

Who needs ENROLLMENT FORM – EMPLOYEE BASIC LIFE & AD&D and GROUP SUPPLEMENTAL TERM LIFE INSURANCE?

01
All employees who wish to enroll in basic life, accidental death & dismemberment (AD&D), and group supplemental term life insurance.
02
Employees who have recently undergone life changes, such as marriage or parenthood, and need updated coverage.
03
Any employees seeking additional financial security for themselves and their families in case of unforeseen circumstances.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
54 Votes

People Also Ask about

The typical group policy is for term life insurance, often renewable each year with a company's open-enrollment process. This is in contrast to whole life insurance, which provides coverage no matter when you die.
AD&D policies provide financial protection against accidental death or injury, but can have a variety of exclusions. These can include intentional self-inflicted injuries, deaths resulting from natural causes, and injuries from illegal activities.
It really depends on your individual needs and lifestyle. If your life insurance policy offers adequate coverage for you in the case of death or accidental dismemberment, AD&D may be an unnecessary additional cost. If you're in a high-risk profession, however, it may be worth consideration.
Basic AD&D is employer-paid coverage, which provides an accidental death benefit often equal to an employee's basic term life insurance amount. Voluntary/Supplemental AD&D offered as employee-paid coverage can be tied to supplemental life insurance coverage or as a separate, stand-alone election.
Basic life insurance covers you and pays your designated beneficiaries in the event of your death. Basic AD&D insurance provides extra benefits for certain injuries or death resulting from a covered accident.
life insurance: What is the difference? Accidental death and dismemberment (AD&D) insurance covers only death or severe injury caused by an accident. If you die from natural causes, no benefit will be paid to your family. Life insurance, on the other hand, covers you no matter what the cause of death*.
Supplemental life insurance pays a benefit for most causes of death. Accidental death and dismemberment (AD&D) provides coverage if you die or are seriously injured from a qualifying accident.
You may want both life insurance and AD&D insurance depending on your personal needs. For individuals in high-risk jobs or for parents of young children who cannot afford a gap in income due to an accident, AD&D insurance may be particularly important.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The ENROLLMENT FORM – EMPLOYEE BASIC LIFE & AD&D and GROUP SUPPLEMENTAL TERM LIFE INSURANCE is a document used by employees to enroll in basic life and accidental death and dismemberment (AD&D) insurance and supplemental term life insurance provided by their employer.
Employees who wish to participate in the employee basic life and AD&D insurance and/or supplemental term life insurance programs are required to file the enrollment form.
To fill out the enrollment form, employees need to provide personal information such as their name, date of birth, social security number, and select the desired coverage amounts as well as any dependent information if applicable.
The purpose of the enrollment form is to collect necessary information from employees to ensure that they are enrolled in the correct life insurance plans and to facilitate the administration of those insurance policies.
The information that must be reported includes the employee's personal details, coverage selections, beneficiary designation, and any relevant health information as required by the insurance provider.
Fill out your enrollment form employee basic online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.