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Employers

Employer Bulletin

All Employers
Vol. 17, No. 22
November 16, 2000

Updated Evidence of Insurability for Group Life Insurance

Updated Evidence of Insurability for Group Life Insurance

The Evidence of Insurability for Group Life Insurance form (ET-2305) (REV 10/2000) has been redesigned, making it accessible to participants and easier to complete and return. Some of the changes include:

  • The application is a two-sided, single ply document with a two-sided cover sheet.
  • The last page of the document contains an area for health information that provides more space for the employee to indicate additional health insurance information, as well as a new area for the employee to list dependent child(ren) information when applying for Spouse and Dependent coverage.
  • The application is available on the Internet and can be downloaded as a four-page document (two-pages include an instruction sheet and plan information sheet, and a two-page application).
  • The employee should be instructed to make a photocopy of the completed Evidence of Insurability application to keep as a record before submitting to ETF because the Department no longer sends acknowledgment copies.

If you have a supply of the old Evidence of Insurability for Group Life Insurance forms (ET-2305) with revision dates earlier than October 2000, please destroy them and use the new forms.

A copy of the new form is attached to this article. The form is also available on ETF's Internet site at http://badger.state.wi.us/agencies/etf under "Employer Forms and Brochures". Copies of the application can be requested from ETF using the order form at the end of this Bulletin.

New Life Evidence Report of Action

A final report of action following approval or denial of the Evidence of Insurability for Group Life Insurance (ET-2305) will be sent to both the employee and the employer in the form of a letter. The letter will provide the following information:

  1. The coverage is approved, with the type(s) of insurance coverage desired, the coverage amount(s), and effective date; or
  2. The coverage is declined; or
  3. The coverage is declined as incomplete.

Ordering New Forms

If you do not wish to access and copy the new Evidence of Insurability for Group Life Insurance (ET-2305) form from ETF's Internet site, you can order copies from ETF. Please allow three weeks for delivery. To order new forms, please use one of the following methods:

  • Request copies from ETF's Supply and Mail Services at (608) 266-3302.
  • Complete the order form located at the end of this bulletin and mail to ETF, PO Box 7931, Madison WI 53707-7931.
  • Fax a copy of the completed order form to ETF at (608) 267-4549.
  • E-mail ETF by clicking "contact us" on our Internet site at http://badger.state.wi.us/agencies/etf and provide the same information requested on the order form.

Remember to destroy your old supply of the Evidence of Insurability for Group Life Insurance (ET-2305) forms with a revision date before 10/2000 once you receive your new supply of the Evidence of Insurability for Group Life Insurance (ET-2305).


ORDER FORM

EVIDENCE OF INSURABILITY FOR GROUP LIFE INSURANCE (ET-2305)

DEPARTMENT OF EMPLOYEE TRUST FUNDS
P O BOX 7931
MADISON WI 53707-7931

Quantity:

Evidence of Insurability for Group Life Insurance (ET-2305) Wanted _____________

Employer Name __________________________________________

EIN Number 69-0360

Your Name ______________________________________________

Title ___________________________________________________

Address ________________________________________________

City ___________________________________________________

State ______________________ Zip Code ____________________

Phone Number ___________________________________________

 

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