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University Human Resource Services

Indiana University
Benefits Change Connection

Enroll in, Change, or Terminate Long Term Disability (LTD) Plan Insurance

All Indiana University full-time employees are eligible for the Long Term Disability Plan.

  1. Review the Long Term Disability Insurance Plan booklet (PDF) and choose a level of coverage. (You may use the Premium Estimator to determine what your monthly premium will be.)
  2. Complete the LTD enrollment/change/terminate form and return it to the campus Human Resources office.

Note:

  1. Initiation of plan participation must be made within 30 days after becoming an eligible employee, by submitting an application form to the campus Human Resources Office.
  2. Application for enrollment or change in coverage option after the first 30 days of eligibility must be accompanied by a Medical History Statement. See below.

 

Forms

LTD enrollment / change / terminate form

Premium Estimator
- Rates before 03/01/12
- Rates after 03/01/12

Employee's Medical History Statement for Indiana Residents (PDF)

Employee's Medical History Statement for Indiana Non-Residents (PDF)

Publications

Plan booklet (PDF)