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Your change in family status may be a qualifying event to add to or remove dependents from your NDPERS group insurance plans within 31 days of the event. Active employees may update their record through Member Self Service (MSS) or by completing the applicable plan enrollment forms. Retirees will need to complete the necessary forms.
Active Employee Forms
- Health Insurance Application or Change [SFN 60036]
- Dental/Vision Enrollment/Change SFN 58792
- Life Insurance Designation of Beneficiary SFN 53855
- Designation of Beneficiary for Group Retirement Plan SFN 2560
- Notice of Change SFN 10766
- FlexComp Change in Status SFN 53511
Retired Member Forms
- Retiree Health Insurance Application SFN 16277
- Retiree Health Insurance with Medicare Application SFN 59562
- Retiree Dental/Vision Enrollment/Change SFN 58792
- Life Insurance Designation of Beneficiary SFN 53855
- Designation of Beneficiary for Group Retirement Plan SFN 2560
- Notice of Change SFN 10766
- Withholding Allowance Election for Pension Payment (SFN 51506) and W-4P
For Qualified Domestic Relations Order (QDRO) information related to a divorce, refer to the retirement plan that applies to your participation.