RESEARCH CORPORATION OF THE UNIVERSITY OF HAWAII
RCUH LIFE INSURANCE BENEFICIARY FORM (75-100% FTE)
Submit via email: RCUH_Benefits@RCUH.com or Fax: 808-956-5022
RCUH USE ONLY Authorized By:
RCUH Form B-5L rev 04/07/15
Employee Name: RCUH Employee ID #:
Employee Email: Employee Phone:
Life Insurance Beneficiary Designation
Percent(s) must total 100%
PLEASE NOTE: Life Insurance companies generally will not disburse payments directly to minor beneficiaries. Payment will normally be made to the legally
recognized guardian of the minor beneficiary, executor of the estate, or The Standard who will retain the benefit amount until minor attains majority age.
I certify the designation of the beneficiary(ies) listed above.
Employee Signature: Date: / /
Your Life Insurance Beneficiary Designation election(s)/change(s) will be effective the date RCUH receives and processes this form.
A confirmation will be sent via email once this form has been processed.
The Beneficiaries of my RCUH life insurance plan provided through The Standard are as follows:
Under the Affordable Care Act, if you are waiving medical coverage
through RCUH, you are obligated under the Individual Mandate to obtain
coverage on your own either through a spouse, the Hawaii Health
Connector, or directly from an insurance carrier.
