Forms for Retirees

• Automatic Withdrawal Cancellation of Insurance Premiums (pdf)
• Choose to Quit Certification Form (pdf)
• Dependent Child Certification (pdf)
• Disability Retirement Packet (pdf)
• Medicare and Your State Health Insurance (pdf)
• Notice of Creditable Coverage (pdf)
• Request or Renew Health Coverage for a Disabled Dependent Child (pdf)
• Retiree and Surviving Dependent Insurance Change Form (pdf)
• Securian/Minnesota Life
• Tobacco Use Certification Form (pdf)
• Verification of Insurance (pdf)