Prudential Life Insurance Enrollment Kit (Effective 01/01/2013)

Information that outlines/ explains the Prudential (Term) Life Insurance benefit coverage offered to the member and their dependents.

2025 Prudential Enrollment and Beneficiary Designation Form

Prudential Life Beneficiary Designation/Change

2024 Prudential Enrollment and Beneficiary Designation Form

Information that outlines/ explains the Prudential (Term) Life Insurance benefit coverage offered to the member and their dependents.

Administration Manual

Application for Conversion of Group Life Insurance

Certificate of Coverage

Preferential Beneficiary’s Statement

Portability Rates

Converting Group Term Life Insurance to Individual Insurance

EOI – Agency Instructions

Evidence of Insurability Form (EOI) (To check status of an employee’s or dependents EOI, please call (888) 257-0412)

Group Accidental Injury Claim Form (AD&D)

Group Life Insurance Claim Form for Agencies/School Boards

Group Life Insurance Claim Form for Beneficiaries

Notice of Group Life Conversion Privilege

Portability Election

Non-Instructional Staff of the Ouachita Parish School Board Certificate of Coverage

Guaranty Association Notices

Life Insurance Administrative Errors Form

Accelerated Benefit Option Claim Form

LSU Grandfathered Employees AD&D Coverage