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Employment Packet - Folder #4 - Supplemental Benefits

After you have submitted the Request for Employment Packet form to the HRM Office and received the email stating which forms are required, print out the required forms for each folder and provide to your new employee for completion. Print out the instruction sheet and use it to guide you through the forms and links on this page.

Forms and Instructions

INSTRUCTION SHEET for  # 1 - 13 below (Completing Documents for Other Miscellaneous Benefits) 

1.    Annual Leave Accrual Rate Election Form  - For Academic and Non-classified only.  (Required)

2.    Tax Sheltered Annuity Programs  (403(b) & 457 Plans)

3.    START - Student Tuition Assistance and Revenue Trust Program          

4.    LSU System Voluntary Benefits Enrollment Form (Required)

5.    Tax Saver Flexible Benefits Plan

6.    Extension Benevolent Life Insurance - for LCES Academic and Non-classified employees only

7.    Hartford Long-Term Disability Insurance 

8.    Group Accident Insurance Coverage

9.    Dental Plans

    • Option 1 - Enhanced Plan   (More information found here.  The Benefit Booklet goes into great detail.)
    • Option 2 - Basic Plan    (More information found hereThe Benefit Booklet goes into great detail.)

10.   Vision Plan

             

11.   LSU Supplemental Term Life Insurance - The Hartford

12.  UNUM Long-Term Care Insurance

Informational Sheets

Forms

Long Term Care Brochure
Long Term Care Medicare Disclosure
Policy Information
Rates for 3 year benefit election
Rates for 6 year benefit election
Benefit Worksheet
Enrollment form
Evidence of Insurability form

Acknowledgement of Disclosure of Rating Practices
Lapse in Payment Notification Designation

13.   LSU Optional Insurance Plan Election Form  (Required)

Related Files
FilenameDescriptionFile Size
UNUM-LTC-Brochure.pdf 170.75 KB
UNUM-LTC-EOI-Form.pdf 57.83 KB
UNUM-LTC-Form-7606-04.pdf 26.96 KB
UNUM-LTC-Medicare-Disclosure.pdf 17.33 KB
UNUM-LTC-Worksheet.pdf 22.38 KB
UNUM-LTC-Packet.pdf 2,335.14 KB
Employment-Packet-Instructions---Folder-4.pdf 176.86 KB
Last Updated: 12/10/2012 11:14:16 AM


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