Complete this form if you prefer to have a smaller portion of your PERA benefit deposited into a secondary account (example: a savings account reserved for monthly payments on a loan). To have the main portion of your PERA benefit deposited into your primary account, please complete the Direct Deposit by Electronic Funds Transfer (EFT) form.
To be completed if you want to allow PERA to release information pertaining to your PERA account to specific individuals/entities. This form does NOT cover release of health care information for PERA members and/or benefit recipients enrolled in PERACare. Complete the Authorization to Use and/or Disclose Personal Health Information (PHI) to authorize release of your health plan information.
Complete this form to certify continuous coverage if you are enrolling based upon first Medicare eligibility, end of COBRA coverage, or loss of previous coverage. (This certification form is not required if you are enrolling at retirement or during an open enrollment period.)