Beneficiary On Health Insurance Form

You may complete 4 different beneficiary forms.

Beneficiary on health insurance form. We recommend that you designate beneficiaries to receive your life insurance benefits. Fegli enrollees and assignees use this form to designate who should receive the death benefits. If you are satisfied with the order of precendence you do not need to file any designations. Attachments are also available for designating a trust.

If you would like a copy of your forms please make a copy or print a second copy for your records. The beneficiary for the policy shall be. If you do it s important to ensure your designations are current. Attachments are also available for designating a trust.

The beneficiary is enrolled in a health insurance plan and receives benefits through the policy in the form of paid claims and or network negotiated rates for the portion of the claim that the beneficiary has to pay. 101 monroe street 7th floor rockville md 20850. Primary beneficiary name address ssn and dob relationship to the covered person of death benefit payable to beneficiary must total 100 in the event and only in the event that all primary beneficiaries predecease me then the proceeds shall be payable to the following contingent beneficiaries. The term beneficiary is also used in the context of life insurance and refers to the person or people who receives payment under the plan in the event that the insured person passes away.

Opm designations of beneficiary page. Please fill out the following forms print them sign them and mail the original copy to the office of human resources.