To submit this form, complete all required fields and provide any necessary supporting documents. Submit the form as directed in the document instructions, which may include emailing it to your employer's HR department, faxing it to the insurance company, or using an online submission portal. Ensure you retain a copy for your records and follow up if you do not receive confirmation of receipt within a reasonable timeframe.

Important dates for this form include the enrollment period typically at the start of the employer's benefit year and deadlines for Evidence of Insurability submission if applicable.

The purpose of this form is to provide detailed information about Group Term Life Insurance available to Marksman Security Corporation employees. It outlines the basic and supplemental coverage options, costs, and benefits, helping employees make informed decisions about their insurance needs. Group Term Life Insurance provides financial protection for employees' beneficiaries in the event of the employee's death. This benefit can be used for various expenses such as funeral costs, co-signed loan debt, future education and more. Understanding the scope of your coverage is crucial in planning for unexpected events. By completing this form, employees can secure the necessary life insurance coverage to ensure their loved ones are financially protected. From basic coverage provided by the employer to additional options that an employee can elect, this document guides the user through the process of selecting the right coverage based on their personal and financial situation.

• 1. Employee Information: Contains details about the employee, such as name, address, and employment information.
• 2. Basic Coverage: Outlines the basic coverage amount provided by the employer at no cost to the employee.
• 3. Supplemental Coverage Options: Allows the employee to select additional coverage amounts for themselves, their spouse, and child(ren).
• 4. Rate Table: Shows the cost of supplemental coverage based on the employee's age and selected coverage amount.
• 5. Evidence of Insurability: A form that must be completed if an employee seeks coverage beyond the guaranteed-issue limit.
• 6. Beneficiary Information: Includes fields for designating beneficiaries who will receive the benefits in the event of the employee's death.

Failing to submit this form may result in a lack of coverage for the employee. It can also delay the processing of applications for additional coverage.

• Loss of Coverage: Without submission, the employee may not have any life insurance coverage through their employer.
• Delayed Processing: Incomplete forms can delay the approval of additional coverage, impacting the employee's ability to secure necessary protection.
• Missed Benefits: Failing to complete the form accurately may result in missing out on important benefits and coverage options.

• 1. Initial Enrollment: Complete this form during your initial enrollment period to secure basic and supplemental coverage.
• 2. Coverage Modification: Use this form to make changes to your existing coverage amounts or add beneficiaries.
• 3. Evidence of Insurability Submission: Submit this form to provide required health information for coverage beyond the guaranteed-issue limit.
• 4. Annual Enrollment Period: Fill out the form during your employer's annual enrollment period to review and adjust your coverage options.
• 5. Life Event Changes: Complete the form if you experience a qualifying life event such as marriage or the birth of a child, which may impact your coverage needs.