Survivors

Steps for Survivors

MOSERS will need several forms completed in order to initiate life insurance or survivor benefits in the event of a member's death. Please look at the scenarios below that best define your situation in order to determine which forms are necessary. It is usually best to contact a benefit counselor to verify eligibility and to be sure you proceed appropriately, especially if you are the survivor of a judge or administrative law judge.

Survivor benefits and life insurance proceeds:

1. Certified copy of the death certificate
2. Original funeral assignment paperwork and itemized funeral expenses (if any)
3. Application for Survivor Benefits
4. Designation of Agent form (if beneficiary is age 18 or older)
5. Direct Deposit Authorization form
6. Tax Withholding form
7. Affidavit of Natural Parent (if beneficiary is under age 18)
8. Affidavit of Family Member (if survivor is disabled or incompetent)

Survivor benefits only (no life insurance proceeds):

1. Photocopy of the death certificate
2. Application for Survivor Benefits
3. Designation of Agent form (if beneficiary is age 18 or older)
4. Direct Deposit Authorization
5. Tax Withholding form
6. Affidavit of Natural Parent (if beneficiary is under age 18)
7. Affidavit of Family Member (if survivor is disabled or incompetent)

Life insurance proceeds only (no survivor benefits):

1. Certified copy of the death certificate
2. Original funeral assignment paperwork and itemized funeral expenses (if any)

Death of a MOSERS member's spouse (to pop-up member's benefit to Life Income Annuity):

1. Photocopy of the death certificate
2. Designation of Life Insurance Beneficiaries form
3. Change Beneficiary to Receive Final Payment form

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