Group and Supplemental Life
Benefit-eligible employees may purchase Supplemental Life Insurance in addition to the group coverage. Rates for this coverage of up to $500,000 are based on the age of the employee. Additional information about this life insurance policy is available from the District Insurance Office or you can view the informational brochures below.
- Basic Life Insurance - District Sponsored Coverage (Employer Paid)
- $15,000 for Part-time Classified Employees after 5 years of consecutive permanent employment.
- $30,000 for Classified, Teamsters, and Certificated Employees
- $50,000 for Managment Employees
- Supplemental Life Insurance - Voluntary Coverage (Employee Paid)
- May 1, 2026 - Present
- Questions for the our department? Call us at (949) 234-9404 or email us at insurance@capousd.org.
- Coverage for CUSD (NY Life Microsite)
- Monthly Rates and Life Insurance Information
- Dependent Spouse coverage cost is based on the Employee age.
- Spring Open Enrollment: Monday, March 23, 2026 - Friday, April 3, 2026
- Another opportunity to enroll will occur during fall Open Enrollment and coverage would become effective January 1, 2027.
- Enrollment Form (Online)
- ***If you are applying for over the guaranteed amounts ($200,000 Employee/ $50,000 Spouse), you will also need to complete and return the Evidence of Insurability form to NY Life (fax or email, listed on form).
- Dependent Coverage
- Dependent Supplemental Life coverage amounts cannot exceed the employee's.
- If you are adding new Supplemental Life coverage for your dependents and they are not currently enrolled in your health benefits (ex. Medical, Dental, and/ or Vision), you will need to provide copies of dependent documentation to our department. Per board policy (1340), if you bring in an original document without a copy, we can make a copy for $0.25 per page (cash only).
- Beneficiary Form
- If you are not looking to make any changes to your current or past beneficiary form, then no action is necessary.
- If you update this form, you can return it our department via fax, district mail, US mail, or in-person. We cannot accept them via email due to SS #'s.
- Fax: (949) 487-0671
- Address: 33122 Valle Road, ATTN: Ins. Dept., SJC, CA 92675
- Hours of Operation: Monday - Friday, 8am - 4:30pm
- If you are not looking to make any changes to your current or past beneficiary form, then no action is necessary.
- Portability and Conversion Forms
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- Basic Life (District Sponsored) and/ or Supplemental Life (Voluntary)
- Policy # FLX971055
- Basic Life (District Sponsored) and/ or Supplemental Life (Voluntary)
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- January 1, 2020 - April 30, 2026
- Group Life
- Supplemental Life
- Application Form
- Beneficiary Form
- Policy Booklets
