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REQUEST FOR CHANGEGROUP LIFE, AND Displease Print or Type To The Employee: Complete this form for changes in coverage for yourself or your dependents. If you are adding dependents because of marriage
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What is GROUP LIFE, AND AD&D Form?

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Group life and AD&D (Accidental Death and Dismemberment) insurance is a type of coverage provided by an employer for its employees, which pays out benefits in the event of death or dismemberment as a result of an accident. It is usually offered as a group policy, covering all eligible employees.
Employers are typically required to file group life and AD&D insurance for their employees, as part of their benefits package.
Employers can usually fill out group life and AD&D insurance forms provided by the insurance carrier, providing information about the employees covered, the coverage amounts, and other relevant details.
The purpose of group life and AD&D insurance is to provide financial protection for employees and their families in the event of a tragic accident resulting in death or dismemberment.
Information such as employee names, coverage amounts, beneficiary designations, and other relevant details must be reported on group life and AD&D insurance forms.
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