Before proceeding to the Group Insurance Beneficiary Form, PLEASE
read the following directions; failure to complete and return the form correctly
will delay your sign up. Direct any questions to one of the Benefits
- Complete the Employee Information Section online.
- Complete the Beneficiary Information Section online.
- Complete the Alternate Beneficiary Information
- Submit and print the completed form by clicking
the "Submit and Print" button on the bottom of the form. When
your printer dialogue box appears, select the appropriate printer and click
- Sign and date the form.
- Return your completed form to Jason
Yager in AB106. Interoffice envelopes
should be addressed to: BISS Center - Jason Yager.
Now that you know what to do, click
here to complete the form! Thank you on behalf of the PA Benefits
Trust Fund Committee.