SSC - HR - Expanded LTD Health Statement Application for Maximum Coverage

This form can be used to request enrollment in Expanded LTD maximum coverage if

•    You are actively at work as defined under the LTD Plan. The definition of actively at work can be found here, and
•    More than thirty (30) days have passed since your date of hire or new appointment in a benefit eligible position

If you are within thirty (30) days of your date of hire/job change in a benefit eligible position, or within thirty (30) days of your two (2) year employment anniversary (3 year employment anniversary if less than half-time), you may use the Expanded LTD Application for Maximum Coverage.

Request Enrollment in Expanded LTD Health Statement for Maximum Coverage


Service ID: 2548
Fri 4/1/22 3:01 PM
Wed 8/2/23 2:17 PM