Forms & Downloads - National Conference on Public Employee Retirement Systems Benefits Marketplace

Enrollment Forms

Employee Enrollment Form (PDF) »

Employee Enrollment Form (Online) »

Beneficiary Change Form »

Retiree Continuation Form »

Online Forms

Change/Update Contact Information Form (members) »

Life Insurance Cancellation Form (members) »

Certificate of Coverage Request Form (members) »

Monthly Autopay Form (members & employers) »

Claim Forms

Death Claim Form »

Plan Brochures

$16 Plan Overview Brochure (GENERIC) »

$16 Plan Overview Brochure (IMRF) »

$16 Plan Overview Brochure (LAPERS) »

$16 Plan Overview Brochure (MASS) »

$16 Plan Overview Brochure (MINN) »

$16 Plan Overview Brochure (PERSI) »

$16 Plan Overview Brochure (SRS IL) »

$16 Plan Overview Brochure (WYO) »

$17 Plan Overview Brochure (FPP) »

Videos & Webinars

VIDEO: $16 Plan Overview »

VIDEO: $17 Plan Overview »

WEBINAR: NCPERS Life Insurance (Employers) »

WEBINAR: NCPERS Life Insurance (Employees) »

Since the plan's inception more than 40 years ago, Prudential has paid over $105 million to NCPERS members and their beneficiaries. It currently serves the needs of over 85,000 public employee retirement system members nationwide.

Accelerated Benefit Option is a feature that is made available to group life insurance participants. It is not a health, nursing home, or long-term care insurance benefit and is not designed to eliminate the need for those types of insurance coverage. The death benefit is reduced by the amount of the accelerated death benefit paid. There is no administrative fee to accelerate benefits. Receipt of accelerated death benefits may affect eligibility for public assistance and may be taxable. The federal income tax treatment of payments made under this rider depends upon whether the insured is the recipient of the benefits and is considered terminally ill. You may wish to seek professional tax advice before exercising this option.

This AD&D policy provides ACCIDENT insurance only. It does NOT provide basic hospital, basic medical, or major medical insurance as defined by the New York Department of Financial Services.

IMPORTANT NOTICE—THIS POLICY DOES NOT PROVIDE COVERAGE FOR SICKNESS.

THIS IS AN EXCEPTED BENEFITS POLICY. IT PROVIDES COVERAGE ONLY FOR THE LIMITED BENEFITS OR SERVICES SPECIFIED IN THE POLICY.

Not for use in New Mexico. Not for residents of New Mexico.

The plan is administered by Member Benefits. Gallagher Benefit Services, Inc. and Member Benefits are not affiliates of Prudential.

©2024 Prudential Financial, Inc. and its related entities. Prudential, the Prudential logo, and the Rock symbol are service marks of Prudential Financial, Inc. and its related entities, registered in many jurisdictions worldwide.

Public Employee Financial Protection Plan, Dependent Group Decreasing Term Life Insurance, and Accidental Death & Dismemberment Insurance are issued by The Prudential Insurance Company of America, a Prudential Financial company, Newark, New Jersey. A Booklet-Certificate, with complete information, including limitations and exclusions, will be provided. If there is a discrepancy between this document and the Booklet-Certificate issued by Prudential, the terms of the Booklet-Certificate will govern. Contract Series: 83500.

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