Life Insurance & Legal Services

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 Forms and Documents
Basic Life Insurance Enrollment Form (Complete Form Online)
Basic and/or Optional Life Insurance Change of Beneficiary Form (Complete Form Online)
Optional Life Insurance and Dependent Life Insurance Enrollment Form (Complete Form Online)
Notice of Death Form
Waiver of Premium Form
Life Insurance Benefits Booklet  (Correction on pages E-F: Plan III Dependent Optional
   coverage $7,500 instead of $7,000 for the Dependent Child, effective July 1, 2011) 

Legal Services Documents
Beneficiary Financial Counseling Brochure
Beneficiary Financial Counseling Poster
FAQs on Will Preparation and Beneficiary Financial Counseling Services
Will Preparation Services Brochure
Will Preparation Services Flyer
Will Preparation Services Poster