Group Life Plan Forms

Forms marked with an asterisk * are fillable. That means you can complete the form on your computer. Once complete, print and sign the form and send it to the address indicated on the form.

Refer to  PEBA Acceptable Documentation for information on specific documents the Public Employees Benefits Agency will use in the administration of your request.


You will require Adobe Acrobat Reader to view and complete any forms. These forms work best with Google Chrome or Firefox web browsers.