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.