2009 MLC Graduate Information

• MLC Health Enrollment Form

As a 2009 Martin Luther College graduate, prior to graduation you should have received an informational packet from the WELS Benefit Plans Office describing the benefits available to you as a WELS called worker.

Please review the items listed below before you enroll in WELS VEBA to ensure the timely processing of your enrollment in the Plan.

• Be sure to accurately complete every section of the Health Enrollment Form:
• A Group Term Life (GTL) beneficiary and his/her relationship to you are required, as GTL coverage in the amount of $25,000 is provided for each policyholder and $12,500 is provided for each policyholder's enrolled spouse. Accidental Death and Dismemberment (AD&D) coverage in the amount of $25,000 for each policyholder is also included.
• Salary information is also required, as Long Term Disability coverage is provided for each active policyholder.
• As the policyholder, the form must be completed and signed by you, not someone else on your behalf.



• Check with your congregation to determine which deductible option they are willing to provide.
• Completed enrollment forms must be postmarked no later than August 31, 2009 for coverage to become effective.
• Sending money will not enroll you--a completed enrollment form is required. Your congregation will be billed for your coverage after your enrollment form has been processed.
• You will automatically be enrolled in the WELS Pension Plan as an eligible WELS called worker. Completion of a Pension Plan enrollment form is not required.

Upon completion, please mail the Health Enrollment Form to the following address: