Long-Term Disability Forms and Documents

Forms

Note: Use the Expanded Long-Term Disability Application with Health Statement in the following circumstances: 

  • More than 30 days have passed since your hire date or date of eligibility and you wish to enroll
  • You have two or more years of service and wish to increase your coverage over the coverage that is paid for by the university

2017 Expanded Long-Term Disability Application with Health Statement

2017 Expanded Long-Term Disability Application

2017 Expanded Long-Term Disability Withdrawal Form

2018 Expanded Long-Term Disability Application with Health Statement

2018 Expanded Long-Term Disability Application

2018 Expanded Long-Term Disability Withdrawal Form

Documents

Basic Long-Term Disability plan book (for AFSCME members only)

Expanded Long-Term Disability plan book