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2021 Enrollment Forms

2021 Prudential Enrollment

The open enrollment period with Prudential for Supplemental Life Insurance and Short-Term Disability plans is open until Friday, December 11, 2020.

If employees would like to view current coverage amounts, add a supplemental life insurance or short-term disability plan, or make any changes to existing plans, click the link to the Prudential website: If employees want to continue their current plans and make no changes, there is nothing they need to do. Employees who have not been previously declined for supplemental life insurance on themselves, are able to enroll for up to the guaranteed issue amount of $300,000 without evidence of insurability or medical approval.

If this is the first time you are accessing the site, click on "Create an Account" and follow these steps:

  1. Enter your Employee ID or Social Security Number.
  2. Enter your Date of Birth: MMDDYYYY.
  3. Enter Access Code: 53939
  4. Click Continue.
  5. To protect your personal information, you must create your own personal User ID and Password. Enter a User ID and Password that you will remember—please note your User ID and Password are case sensitive. Your User ID must contain letters and numbers and be at least eight characters long.
  6. Answer the remaining questions. Click Submit.


If you have any questions you can send an email to: