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2023–2024 Program Guide Applying for Life and LTD Coverage Process Online Benefits System User Login Important Documents and Forms NMPSIA Participating Employer Contact Database

Important Documents and Forms

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  • 1-1-25 Enrollment Change Form
  • Beneficiary Questions and Answers
  • Sample Loss of Coverage Form
  • Release of Health Information
  • Affidavit for Domestic Partner
  • Termination of Domestic Partner
  • LTD Claim Packet
  • Retiree Life Insurance Application
    (under age 65)
  • Options for Continuing Life Insurance
    Due to Retirement
  • Life Claim Packet
  • Board Member Enrollment Application
  • Notice of Work Accident