This instructional sheet will assist you during open enrollment in completing the PERACare Enrollment/Change Form Combination Pre-Medicare and Medicare Coverage—2021.
Complete this form to change your life insurance beneficiary in a disability waiver of premium policy. All other life insurance coverage is administered by Unum and uses a different form.
To be completed by children of deceased PERA members who are receiving a benefit contingent on their enrollment in an accredited, non-traditional school on a full-time basis.
To be completed to change address only information on an existing account. It changes address information for PERA Defined Benefit (DB) account(s), life insurance, PERAPlus 401(k), PERAPlus 457, and DC accounts.
