Life Event? Update these forms

Please fill out the appropriate forms below and return to HR

Employee Emergency Information Sheet

• Employee Emergency Info Form - to update Emergency Contact Info

Health Enrollment:

• must be done within 60 days of life event. MUST provide supporting documentation (e.g., marriage or birth certificate, proof of loss of coverage)

Dental Enrollment:

• United Concordia Dental Enrollment Form

Vision Enrollment:

(SRFA employees not eligible)

• EyeMed Enrollment/Change Form

Life Insurance:

(for regular employees, greater than 75% FTE)

• Voluntary Life Insurance Application (to purchase coverage for spouse, up to 50% of employee coverage) - must be done within 30 days of life event
• Beneficiary Designation form (for Basic and/or Voluntary Life Insurance)

457 Deferred Comp Beneficiary Designation Forms:

• Missionsquare
• Nationwide

Marin County Employees' Retirement Association (pension for regular employees, 75% or greater FTE):

• MCERA Beneficiary Change Form
• MCERA Name Change Form

PARS (for part-time & fixed-term employees, less than 75% FTE):

• PARS Beneficiary Change Form