Fillable Beneficiary For Group Life Insurance Form (Page 2 of 2) in pdf

Payment of Group Life Insurance Benefits

Beneficiary for Group Life Insurance



If you name your estate, a trust, or one beneficiary (and

that one beneficiary survives you), payment will be made

How to Complete the “Your Life Insurance Beneficiary

in full as designated after your death.

Designation” Section



If you name more than one beneficiary, payment will be

made in equal shares to the named beneficiaries who

 To designate a beneficiary or beneficiaries, complete this

survive you (or in full to the survivor if only one beneficiary

form as follows.

survives you), unless you enter a specific percentage for

 Under Primary Beneficiary, list person(s) whom you wish to

each person.

be paid first. Under Contingent Beneficiary, list person(s)



If no named primary or contingent beneficiary survives

whom you wish to be paid only if no Primary beneficiary

you, payment will be made to the first of the following:

survives you.

• Your surviving spouse

 Percentage: If you list more than one beneficiary, and you

• Surviving children in equal shares

wish the beneficiaries to receive specific percentages,

• Surviving parents in equal shares

enter the percentage in the space provided under the

• Surviving siblings in equal shares

person’s name. List whole percentages only. Actual dollar

• Estate

amounts are not valid. Check your math to be sure the



Consider discussing your beneficiary designations with your

percentages listed equal 100%.

attorney when completing this form. The Benefits Office

 If your beneficiary is not related to you, show the

cannot provide legal advice.

relationship as “Friend.”

 If you wish to name your estate, insert “Estate” on the

Important Note

Legal Name line in the first box under Primary Beneficiary.

This form is only for changing your life insurance beneficiaries.

 If you name a beneficiary who is a permanent resident of a

There are separate beneficiary designation forms for the

foreign country, furnish that person’s full current address,

TIAA-CREF retirement savings plan and the Fidelity retirement

to assist in locating the person.

savings plan. If you have money in both TIAA-CREF and Fidelity

 If you wish to name a trust, under Primary Beneficiary,

retirement accounts, you must complete a separate beneficiary

write the complete name(s) of the trustee(s) and

form for each account. For more information and to download

successor(s), and the date of the trust. Note: This

the beneficiary forms, see the Benefits Office website at

document does not create a trust.

benefits.umich.edu/events/beneficiary.html.

 If you wish to name more beneficiaries than there are

spaces provided on this form, please attach a separate

How to Return Your Signed and Complete Form:

sheet. Include on that sheet your name, your UMID or U.S.

Social Security Number (if UMID is unknown), and the

Make a copy for your records and mail to:

name, address, relationship to you, and percentage (if you

wish to indicate a specific percentage) for the additional

MetLife National Benefit Center

named beneficiary or beneficiaries. Sign and date the

P.O. Box 14406

separate sheet so that it will be valid.

Lexington, KY 40512-4406

 The beneficiary for the Travel Accident Insurance Plan will

be the same as the beneficiary you designate for your

Or fax to MetLife:

859-825-6719

Group Life Insurance Plan. If you wish to make a different

designation you may do so by requesting a paper

beneficiary form by calling the SSC Contact Center at

734‐615‐2000 or 866‐647‐7657 (toll free).

 Keep a copy of this form for your records.

Questions?

If you have any questions, view the Benefits Office website at benefits.umich.edu, call MetLife at 866-492-6983, or call the SSC Contact

Center at 734-615-2000 or 866-647-7657 (toll free), Monday through Friday from 8 a.m. to 5 p.m.

Keep a copy for your records and

Or fax your signed and completed form to MetLife:

mail your signed and completed form to:

859-825-6719

MetLife National Benefit Center

P.O. Box 14406

Lexington, KY 40512-4406

BenifChg09242014

Beneficiary For Group Life Insurance Form Page 2

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