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Life Insurance Enrollment Form - Human Resources - University of - hr utah

Life Insurance Enrollment Form - Human Resources - University of - hr utah 2025

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The document is a Life Insurance Enrollment Form for employees at the University of Utah, detailing various life insurance coverage options available through The Hartford. It includes sections for basic employee life insurance, supplemental term life insurance for employees and their spouses, and dependent child coverage. The form requires beneficiary designations and provides information on premium rates based on age and tobacco use. Employees must certify their information and authorize payroll deductions for premiums.

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