Dow Spouse Insurance Form

If you are unsure of your dow eeid please contact the dow retiree service center at 800 344 0661.

Dow spouse insurance form. Please use this form to designate your beneficiary for the coli incentive benefit plan. Coli incentive beneficiary form. Employee number or last 4 digits of ss spouse domestic partner name select the applicable statement my spouse domestic partner is employed and is eligible for medical coverage through his her employer which. A former spouse s application to enroll can either be a completed health benefits election form sf 2809 or a written notice of intent to apply for health benefits.

If your spouse domestic partner is unable to enroll in his her plan at this time. If you wish to cover your non dow spouse domestic partner as a dependent under the dow medical and or dental plans then he she must enroll in his her employer s plan and dow coverage will be secondary to his her employer s primary coverage note. Company paid life insurance employee paid life insurance dependent life insurance for spouse domestic partner and or child ren beneficiary. Dow is committed to providing you with the resources you need to reach your personal and professional goals.

Please see the information about creating an account on the right otherwise continue as a returning user below. You will receive a confirmation email from dow benefits once approved. If you wish to cover your non dow spouse domestic partner as a dependent under the dow medical and or dental plans then he she must enroll in his her employer s plan and dow coverage will be secondary to his her employer s primary coverage note. The enrollee s name and date of birth must be entered in the remarks section.

Life insurance dow offers three life insurance plans to employees and eligible dependents. Information regarding my employer s health insurance plan and. If you are a surviving spouse please use the last 4 digits of your dow eeid as the id code on the claim form. These benefits offer an important source of financial assistance for you and your survivors.

Spousal domestic partner employment verification form. If you are commencing your pension and wish to add a domestic partner as your surviving spouse complete this form attaching all required documentation. His her own name date of birth and social security number are entered on part a of the sf 2809. This form may be used by certain salaried and midland hourly retirees who signed and submitted a coli consent form on whom the dow chemical company purchased a corporate owned life insurance coli policy on their lives.

If you have not logged in to the dow benefits website since june 21 2019 you will need to create a new account.