Memorandum of understanding

Memorandum of understanding between HCA and an employer group.

Form

MetLife (SEBB) Life and AD&D insurance Certificate of Coverage (COC) full-time employees 2020

MetLife life and accidental death and dismemberment insurance certificate of coverage for full-time school employees enrolled in SEBB benefits.

Publication

MetLife (SEBB) Life and AD&D insurance Certificate of Coverage (COC) part-time employees 2020

SEBB MetLife Life and accidental death and dismemberment insurance Certificate of Coverage for part-time employees 2020.

Publication

MetLife (SEBB) life insurance beneficiary designation

Use this form to name the persons or entities you want to receive your life insurance proceeds after your death. Return this form to MetLife.

Form

MetLife cancellation of life insurance - retiree 2019

51-857

Use this form to notify MetLife that you wish to cancel your Retiree Life Insurance. If you cancel your Retiree Life Insurance, you may not reenroll in life insurance unless you regain eligibility for life insurance at a later date.

Form

MetLife cancellation of life insurance - retiree 2020

51-0011

Use this form to notify MetLife that you wish to cancel your Retiree Life Insurance. If you cancel your Retiree Life Insurance, you may not reenroll in life insurance unless you regain eligibility for life insurance at a later date.

Form

MetLife cancellation of supplemental life and AD&D insurance (SEBB)

Use this form if you are a School employee and you wish to cancel your supplemental life and/or accidental death and dismemberment (AD&D) insurance.

Form

MetLife cancellation of supplemental life insurance form - PEBB employee 2019

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental Accidental Death & Dismemberment (AD&D) Insurance. For employees only: Employee Basic Life Insurance ($35,000) and Employee Basic AD&D Insurance ($5,000) is not affected by this form. It is provided by your employer at no cost to you. You cannot cancel your Employee Supplemental Life Insurance and keep Dependent Life Insurance.

Form

MetLife cancellation of supplemental life insurance form - PEBB employee 2020

50-911

Use this form to notify MetLife that you wish to cancel your Supplemental Life Insurance and/or Supplemental Accidental Death & Dismemberment (AD&D) Insurance. For employees only: Employee Basic Life Insurance ($35,000) and Employee Basic AD&D Insurance ($5,000) is not affected by this form. It is provided by your employer at no cost to you. You cannot cancel your Employee Supplemental Life Insurance and keep Dependent Life Insurance.

Form

MetLife employee enrollment/change form (PEBB) 2020

Use this form to enroll in or change enrollment in basic life and AD&D insurance, as well as optional life, and/or AD&D insurance for yourself and your dependents. You may need to complete a statement of health. Return this form to MetLife.

Form

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