MetLife benefits
Benefits Enrollment
Review your information and explore your coverage choices. When available, this form will send your elections to Customer Care for processing. Submitting a request will not confirm that coverage is active.
Your name and company will be filled in from your employee portal. If either is incorrect, contact your benefits team before continuing.
Your name and company come from your employee portal.
Contact information
Confirm the email and phone number you would like us to use for this enrollment.
Changes here apply to your enrollment contact details. They do not update your employee record.
Choose whether to elect or waive each benefit. If you elect coverage, choose the plan and coverage level where shown. No choices have been made for you.
This preview follows the paper enrollment form. Updated rates and final plan rules are pending. Selections here are examples only and cannot be submitted.
Spouse coverage requires spouse details. Child coverage requires at least one child. Family coverage requires a spouse and at least one child. Complete every dependent you add; add each person only once. Only people included in your selected coverage appear in the review.
SSNs are masked while you type. Use the eye button to show or hide the number. Nothing is sent or saved in this preview.
No dependents added.
If you elect supplemental life coverage, provide beneficiary details. Shares must total exactly 100%, even if you name only one beneficiary.
Select “Elect coverage” under supplemental life to try this section.
No beneficiaries added.
Review each benefit and the people you have included before submitting your elections for processing.
Your sample election summary
This summary is for design review only. It does not confirm eligibility, cost, or active coverage.
The signature method is a design proposal. Nothing is signed or submitted in this preview. The typed signature must match the employee name shown above.
Customer Care will process your request and follow up if more information is needed. A submission acknowledgment will not confirm that coverage is active.