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Remember, we encourage you to complete your annual enrollment elections online through Member Self Service (MSS).
The only form that you may need to print, sign, and submit to your HR or payroll department by Friday, November 1 is the Evidence of Insurability when making specific changes to your life insurance coverage. All other annual enrollment changes can be completed on MSS.
Forms policy
If you are submitting a form, keep in mind: Completed forms must be submitted to your employer by fax, by mail, or as a scanned PDF.
Your employer will forward your completed forms to NDPERS at least weekly during annual enrollment. All annual enrollment forms must be received by your employer no later than Friday, November 1.
NDPERS does not accept picture files such as .jpeg, .jpg, .tif, or .png.
Select form(s) to download:
- Health Insurance: Health Insurance Application or Change (SFN 60036)
- Life Insurance
- Life Insurance Enrollment/Change (SFN 53803)
- Voya Life Insurance Evidence of Insurability (EOI): Do not complete section B. Do not send EOIs directly to Voya.
- FlexComp: Annual FlexComp Enrollment 2025 Plan Year (SFN 17759)
- Dental or Vision Insurance: Dental/Vision Insurance Application or Change (SFN 58792)