Life Insurance Benefit Enrollment Form

New Hires or Additional Life Insurance Requests Required Form: Dependent Life: Eligible Dependent Child(ren) means: *1) Your unmarried Child until age 19 or age 23 if a full-time student. Full-time student means a registered student in full-time attendance at an accredited educational institution, including vocational training. 2) Child includes a stepchild or legal ward, a child placed in the home for adoption and/or a legally adopted child. 3) Disabled Child