Beneficiary Forms

Defined Benefit Beneficiary Forms

Active and Deferred Members Beneficiary Designation (DB only)
Gen053 [PDF 110K]
Designation of Beneficiary for Unpaid Compensation (State of AK employees only)
dbuncp [PDF 29K]
PERS Voluntary Employee Savings Plan Beneficiary Designation
pers051 [PDF 120K]

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Defined Contribution Beneficiary Forms

  • Deferred Compensation Plan (DCP) Beneficiary Designation
  • Supplemental Annuity Plan (SBS-AP) Beneficiary Designation
  • PERS Defined Contribution Retirement Plan (PERS DCR) Beneficiary Designation
  • TRS Defined Contribution Retirement Plan (TRS DCR) Beneficiary Designation

Empower Retirement Services processes all forms for the DCP, SBS-AP, and PERS and TRS DCR plans. You should contact Empower Retirement Services for information on how to set up your beneficiary designation information.

To contact Empower Retirement Services, call (800) 232-0859.

Find more information on Empower Retirement Services here.

Please note: This designation supersedes all prior designations. Beneficiaries will share equally if percentages are not provided and any amounts unpaid upon death will be divided equally. Primary and contingent beneficiaries must separately total 100.00%. The number of primary or contingent beneficiaries you may name is not limited. Attach an additional sheet if necessary.

If you are married and you are not listing your spouse as at least 50% of your primary beneficiary then your spouse will need to complete a Spousal Consent process with Empower Retirement Services.

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Employee Health and Optional Benefits Beneficiary Forms

Changes to beneficiary designations as well as enrollment into Basic/Select Life and AD&D, and Voluntary Supplemental (Optional) Benefits for active employees are now processed by BENEFITFOCUS. To make changes or enroll, please visit their website.

If you have any questions, please contact (844) 939-0543 or Benefitfocus is open Monday-Friday 8 a.m. – 8 p.m. EST.

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Retiree Health and Optional Benefits Beneficiary Forms

Retiree Beneficiary Designation
Gen053 [PDF 110K]
Retirees Select/Optional Life Insurance Continuation/Waiver
02-1858 [PDF 127K]

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