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.