Life Insurance

If a form has (Complete Form Online) next to it, you can complete it online by going to Manage My Benefits. It's easier, faster and leads to fewer mistakes than printing a form and sending it to PEIA.

Life Insurance

Plan Year 2023 Information - Active Members and Retirees

Basic Life Insurance Enrollment Form (Complete Form Online)

Optional Life Insurance and Dependent Life Insurance Enrollment Form (Complete Form Online)

Retiree Basic Life and Health Enrollment Form

Retired Employee's Optional and Dependent Life Insurance Enrollment Form

Disability Life Insurance Premium Waiver

Basic and/or Optional Life Insurance Change of Beneficiary Form

Basic and/or Optional Life Insurance Beneficiary Form

Active Employee Life Insurance Plan Certificate (Effective July 1, 2022)

Retiree Life Insurance Plan Certificate (Effective July 1, 2022)

IMPORTANT NOTE REGARDING BENEFICIARIES: To view and/or change beneficiaries for your plan, please visit mybenefits.metlife.com/. For more information, please contact MetLife at 888-466-8640. To file a death claim, please call 800-638-6420, Option 2.

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Life Insurance

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