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Employee Benefits

SC RETIREMENT SYSTEMS | Access the forms listed below on the PEBA website forms page

  • Retirement Plan Enrollment Form 1100
  • Active Member Beneficiary Form 1102
  • State ORP Beneficiary Designation Form 1106
  • Request for Service Purchase Request 2101

EMPLOYEE INSURANCE PROGRAM | Access the forms listed below on the PEBA website forms page

  • Active Notice of Election Form
  • Certification Regarding Tobacco Use
  • COBRA Notice of Election Form
  • Dependent Social Security Number Form
  • MoneyPlu$ Enrollment Form
  • MoneyPlu$ Health and Dependent Day Care Reimbursement Claim Form
  • MoneyPlu$ Spending Accounts Change in Status Form
  • Incapacitated Child Certification Form
  • Life Insurance Statement of Health (MetLife)

Health and Wellness Programs

MISCELLANEOUS