PRUDENTIAL LIFE INSURANCE FORMS

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.

LSU Grandfathered Employees AD&D Coverage

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)

Evidence of Insurability Form (EOI) Short Form (Only Available during Annual Enrollment)

Online Evidence of Insurability (EOI) Short Form Application

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