Special Enrollment for Domestic Partner Coverage

Individual and Family Group Term Life Insurance
Policy 32871-G

Current University of Wisconsin System and University of Wisconsin Hospital and Clinics employees enrolled in the Individual and Family Life Plan have a special enrollment opportunity from April 5 - 23, 2004 to enroll their domestic partners and the domestic partner's eligible children into the Individual and Family Life Plan. Interested plan participants must submit an application and a Domestic Partner Affidavit to their benefits office by 4:30 p.m. on April 23, 2004. Coverage will become effective June 1, 2004. For more information, view the certificate endorsement describing this new benefit offered by University of Wisconsin System.

Domestic Partner Coverage

You may select $5,000 or $10,000 in coverage for the domestic partner. This amount may be increased during future Annual Increase Option periods. The premium is based on your age.

Note: A domestic partner who is also an eligible employee may be insured as an employee or as a partner but not both. Only one partner can carry coverage for dependent children.

Dependent Child Coverage

Eligible children of your domestic partner are also eligible for coverage if:

You may select $2,500 in coverage for a monthly premium of $.30 or $5,000 in coverage for a monthly premium of $.60 for the children of your domestic partner. If dependent coverage is elected, all eligible dependents are covered.

If you already have child coverage, your domestic partner's eligible children will be insured at the same amount of child coverage now in force.

If you have dependent children who were eligible for coverage but coverage was declined, the children of your domestic partner are not eligible to enroll through this enrollment.

Beneficiary Designation

You should complete a new Beneficiary Designation to ensure benefits are paid to the beneficiary of your choice. If a Beneficiary Designation is not on file, benefits are paid in accordance with a standard sequence which does not include domestic partners.

Domestic Partner Requirements

If you are in an established domestic partnership of at least six months, you and your partner must complete and submit the Domestic Partner Affidavit to your staff benefits office. By completing the Affidavit, you are certifying that you and your partner meet the criteria set forth in the document. The domestic partner may be of the same sex or the opposite sex.

Future Enrollment Opportunities

If you are currently in a domestic partnership that has lasted over six months, this enrollment opportunity is the only time you'll be able to add coverage for your domestic partner and his or her children, without having to provide evidence of insurability.

For partnerships that have not yet met the six-month requirement or that occur in the future, enrollment for the domestic partner of an existing employee must occur within 30 days of meeting the criteria for a domestic partnership and the completion of the Domestic Partnership Affidavit. The domestic partner and children may later apply through evidence of insurability.

Termination of a Domestic Partnership

If you have coverage for a domestic partner and his or her dependent children and the partnership terminates, please contact your benefits office and complete a Statement of Termination (form UWS-51). There is a six month qualifying period before another domestic partnership can be certified.

The Individual and Family Group Term Life Insurance Plan is a life insurance contract between Minnesota Life and the Board of Regents of the University of Wisconsin System. The plan is self-administered by the University in accordance with insurance industry standards.

Return to Top

This document was last revised on March 19, 2004