Form Kpers-7/99a - Designation Of Beneficiary For Life Insurance Page 2
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2„ Who Can Use This Form?
This form is for Board of Regents members who do not have any KPERS service credit. This form designates a
beneficiary for your KPERS life insurance benefits only. Please see your designated agent about designating a
beneficiary for your Board of Regents benefits.
„ Who Can You Name as Beneficiary?
You can choose:
• A living person
• A trust
• Your estate
• Any combination of these options.
If you choose more than one beneficiary, each will share your life insurance benefit equally. You can also name a
contingent beneficiary to receive your benefit if your primary beneficiary is not living. Only members can com-
plete the designation form. Conservators, guardians and those with power of attorney cannot select or change
a beneficiary. Each time you complete a beneficiary form, it cancels all those you have previously completed.
Every time you complete the form, fill in both the primary and contingent beneficiary sections if you intend to
have a contingent beneficiary. If you complete only the contingent section and leave the primary blank, you will
have no primary beneficiary, even if a past form names one. When completed, this form stays with your employer.
„ Naming a Trust or Estate
If you name a trust, provide the name of the trust (e.g., Your Name, Trust #1). If you name your estate, write
“Estate of (Your Name)” or “My Estate.” You can name another primary or contingent beneficiary in addition to
your estate or a trust, and each will share your benefit equally.
„ Naming Additional Beneficiaries
If you need to name more beneficiaries than space allows, please use an Additional Life Insurance Beneficiaries
page. This page must be with your completed Designation of Beneficiary for Life Insurance form to be valid. You
can download additional pages at or get one from your designated agent.
„ If You Have Any KPERS Service Credit
This form is for Board of Regents members who do not have any KPERS service credit. If you are a Regents member
and have any KPERS service credit, you need to complete a Designation of Beneficiary form (KPERS-7/99) instead.
This form will allow you to name a single beneficiary or separate beneficiaries for your life insurance benefits and
KPERS retirement benefits. You can get one at or from your designated agent.
If you do not name a beneficiary on a Designation of Beneficiary form (KPERS-7/99), your KPERS retirement
benefits will be paid according to the line of descendency in K.S.A 74-4902(7).
For additional information on designating a beneficiary, please visit .
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