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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 - 14 below (Completing Documents for Other Miscellaneous Benefits) 

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

2.    LSU System Voluntary Benefits Enrollment Form (Required) Numbers 3 - 7 are to be enrolled/declined on this form.

3.    Dental Plans

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

4.    Vision Plan

5.     Group Accident Insurance Coverage - Accidental Death & Dismemberment (this link contains information about the policy)

6.     Hartford Long-Term Disability Insurance

7.     Premium Only - Tax Saver Plan - Eligible employees may tax shelter insurance premiums for medical, dental, vision and life 
        insurance offered through the Office of Group Benefits (with the exception of the dependent life premium). There is no 
        charge for participating in this option. Election to participate automatically renews each year unless changed during the annual 
        enrollment period. 


8.    Tax Saver Flexible Benefits Plan

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

10.   LSU Supplemental Term Life Insurance - The Hartford

11.   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

12.   LSU Optional Insurance Plan Election Form  (Required)

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

14.  START - Student Tuition Assistance and Revenue Trust Program

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: 12/2/2013 10:38:45 AM


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