SSC - HR - Expanded LTD 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
    • You are within thirty (30) days of:
      • Your date of hire in a benefit eligible position
      • Your newly, benefit eligible appointment due to a job change
      • Your two (2) year employment anniversary (3 year employment anniversary if less than half-time

If you are outside of the thirty (30) day window you must use the Expanded LTD Health Statement Application for Maximum Coverage form.

Request Enrollment in Expanded LTD Maximum Coverage


Service ID: 2573
Wed 4/27/22 11:34 AM
Wed 8/2/23 2:17 PM