Find Your Plan Highlights E-Book.

Learn about the key features of your retirement plan. Find the Plan Highlights e-book that’s right for you.

• Defined Contribution (DC) — Personal Healthcare Fund.
• Defined Contribution (DC) — Subsidized Retiree Insurances.

 Not sure which plan you’re in? Use this chart to find your state employee retirement plan and your Plan Highlights e-book. 

Application for Military Leave of Absence Credit (R0717G)

Upon returning from a military leave of absence that interrupted your State of Michigan employment, complete this form to request service credit and employer contributions to your Defined Contribution retirement plan during active-duty military service performed while a State of Michigan employee.

Application for Military Leave of Absence Credit (R0717G)
Upon returning from a military leave of absence that interrupted your State of Michigan employment, complete this form to request service credit and employer contributions to your Defined Contribution retirement plan during active-duty military service performed while a State of Michigan employee.

Retirement Application Forms

Read these documents to learn about insurance options in retirement, insurance rates for retirees, and privacy practices. 

Insurance Options Sheet (R0423GH)
This document outlines the insurance options available to participants of the State Employees' Retirement System. Please read it carefully as you make decisions about your continued insurance coverage.

Retiree Insurance Rates (R0749G)
This form provides basic information about current health, dental, and vision insurance rates for State of Michigan retirees in the Defined Contribution Plan.

ORS Group Health Plans Notice of Privacy Practices (R1054X)
This form explains how your medical information may be used or disclosed.

Complete and submit these forms to the Michigan Office of Retirement Services (ORS) to apply for retirement benefits. We recommend you apply about three months before you want benefits to start.

Insurance Eligibility Notice (R0517G)
Submit this document about three months before you, your spouse, or your dependents meet the insurance eligibility requirements. 

Insurance Enrollment/Change Request (R0752G)
Use this form to enroll in the retirement system’s insurance plans; change from one insurance plan to another; or add, delete, or change a name or address for anyone on your existing insurance coverage. Also use this form to notify ORS if you, your spouse, or any of your covered dependents become eligible for other health, dental, vision, or prescription group insurance coverage, including Medicare.

Life Insurance Beneficiary Designation (R0782GHB)
Use this form to designate your primary and secondary beneficiaries for your life insurance.

Read these documents to learn about insurance options in retirement, insurance rates for retirees, and privacy practices.

Insurance Options Sheet (R0423GH)
This document outlines the insurance options available to participants of the State Employees' Retirement System. Please read it carefully as you make decisions about your continued insurance coverage.

Retiree Insurance Rates (R0749G)
This form provides you with basic information about current health, dental, and vision insurance rates for State of Michigan retirees who are in the Defined Contribution Plan.

ORS Group Health Plans Notice of Privacy Practices (R1054X)
This form explains how your medical information may be used or disclosed.

Complete these forms when you want to enroll or change your insurance enrollment after you retire or to update your life insurance beneficiary.

Insurance Enrollment/Change Request (R0752G)
Use this form to enroll in the retirement system’s insurance plans; change from one insurance plan to another; or add, delete, or change a name or address for anyone on your existing insurance coverage. Also use this form to notify the Michigan Office of Retirement Services (ORS) if you, your spouse, or any of your covered dependents become eligible for other health, dental, vision, or prescription group insurance coverage, including Medicare.

Life Insurance Beneficiary Designation (R0782GHB)
Use this form to designate your primary and secondary beneficiaries for your life insurance.

If you have a health reimbursement account (HRA) after retirement, you’ll receive a letter from ORS about your HRA balance and how to submit claims. 

Health Reimbursement Account (HRA) (R1047X)
This sheet provides information about the HRA tax-advantaged health savings plan.

Health Reimbursement Account (HRA) Claim Form (R1042X)
Use this form to submit HRA claims to ORS.

Release of Information Authorization (R3488CGHBD)
To request a copy of documents located in your Michigan Office of Retirement Services account, please complete, and submit this form.

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