A surviving family member should contact the Benefits Office immediately for information concerning benefits upon death.

Wisconsin Retirement System	State Group Health Insurance	EPIC Benefits+
Dental Insurance	Income Continuation Insurance	State Group Life Insurance
UIA Life Insurance	Individual and Family Group Life Insurance	UW Employees Inc. Life Insurance
AD&D Insurance	Employee Reimbursement Account	Tax Sheltered Annuity /Deferred Compensation Programs

WISCONSIN RETIREMENT SYSTEM (WRS)

Beneficiaries are entitled to a death benefit whether your death occurs while you are an active employee or after you have terminated employment under the WRS, provided you did not close your account. (After you begin a WRS annuity, death benefits are governed by the annuity option you chose.)

Death benefits will be paid according to the beneficiary designation on file with the Department of Employee Trust Funds (ETF).

You should know. . .

• If you die as an active employee before reaching minimum retirement age (age 55 for most; age 50 for protective occupation participants), OR if your beneficiary is not a living person or a trust in which a living person has a beneficial interest, your death benefit is the "regular death benefit,", i.e., two times the balance in your WRS employee-required account, plus any voluntary additional contributions in your account.
• If you die as an active employee after reaching minimum retirement age AND your beneficiary is a living person or a trust in which a living person has a beneficial interest, the higher of two death benefits is payable:

• The regular death benefit, or
• A special death benefit, calculated as though you retired on the date of death and selected a joint survivor annuity continued in full to your beneficiary(ies).

Former employees ("inactives") have different death benefit provisions.

What the survivor should do...

• Submit a completed Benefit Information Request form to ETF:

Department of Employee Trust Funds
PO Box 7931
Madison, WI 53707-7931
Customer Service: 1-877-533-5020 (toll free)
Fax: 608-267-4549

• A certified copy of the death certificate is required. ETF will send the beneficiary information about survivor benefits and how to apply for them, or
• Request assistance from the Benefits Office.

STATE GROUP HEALTH INSURANCE

You should know...

If family coverage was in effect at the time of death:

• Your spouse may continue coverage for life under the State Group Health Insurance.
• Your eligible dependents may continue coverage until they lose dependent status.
• Premiums may be paid from your sick leave credits until these are used up. Thereafter, premiums must be paid from the beneficiary's annuity, if any, or else directly to the insurance provider.
• Except for your sick leave credits, your spouse and/or dependents will be responsible for the entire premium. This is substantially more than you paid as an active employee.
• If you had family coverage and your surviving spouse is also a state employee, he or she may choose between enrolling for coverage in his or her own name or as a surviving spouse.
• Your sick leave credits may be escrowed for future use.
• Surviving dependents covered under the graduate assistant health plan do not have the right to continue coverage indefinitely. They may, however, elect COBRA coverage which allows the surviving dependents to continue coverage for up to thirty-six months.

What the survivor should do. . .

• Contact the Benefits Office about continuation of coverage.
  • ETF will send spouse or dependents an application form and notify them of sick leave credits available to pay health insurance premiums and method of premium payment.
  • The employee's sick leave credits may be escrowed for future use if the survivors have comparable health insurance coverage.

• Return the health insurance application form for continuation of coverage to ETF within 90 days of the date of death.

EPIC Benefits+

You should know. . .

• Surviving spouse and eligible dependents covered at the date of death are eligible to continue coverage indefinitely by sending timely premium payments to the EPIC Insurance Company.
• An accidental death benefit is included in the plan.

What the survivor should do. . .

• If interested in continuing the group EPIC Benefits+ coverage, survivors should contact the Benefits Office to:
  • Obtain a continuation form for covered survivors.
  • Obtain an enrollment form to establish a new primary subscriber for covered survivors.

• Return the completed continuation form to EPIC within 60 days following termination of coverage.
• Send the payment to EPIC within 45 days of the election to continue coverage.
• If the death was accidental, submit a death benefit claim form and death certificate to Epic.

You should know. . .

• Surviving spouse/domestic partner/dependent child(ren) are eligible to continue Dental Wisconsin for 36 months after the date of death, if family coverage was in effect at the time of death.

What the survivor should do. . .

If family coverage was in effect at the time of death and the survivor(s) wants to continue coverage, the survivor should:

• Complete a Dental Wisconsin continuation form (the employee's Benefits Office will issue this to the survivor) and Dental Wisconsin application to transfer coverage to the survivor.
• Send the completed continuation form and application to:

The EPIC Life Insurance Company
PO Box 8430
Madison, WI 53708-8430

Union-Sponsored Dental Insurance for Represented Employees

Consult your union representative for information.

INCOME CONTINUATION INSURANCE

You should know. . .

• Coverage terminates on your date of death.
• Benefits for which you had applied and were eligible are payable through the date of death.
• Benefits are not payable to survivors.

STATE GROUP LIFE INSURANCE (Minnesota Life Insurance Company)

You should know. . .

• A death benefit for the amount of coverage in force under Basic, Supplemental and Additional will be paid according to the beneficiary designation on file with ETF at the time of death.
• In the event of an accidental death, the amount of benefit is equal to two times the amount of Basic, Supplemental and Additional coverage. (Death must occur within one year of the accident.)
• Premiums are payable through the month of death.
• If Spouse and Dependent coverage was effective at the time of death,
  
  • the spouse and eligible dependents are covered for 90 days after the employee's death, and
  • the spouse and eligible dependents may convert to an individual policy.

What the survivor should do. . .

• Contact the Benefits Office. The employer will notify ETF. Under direction by ETF, Minnesota Life Insurance Company sends a death claim statement to the beneficiary and requests an official death certificate.
• Survivors may choose a conversion plan, provided Spouse and Dependent coverage was in force at the time of death. Submit a conversion application, along with the premium payment, to Minnesota Life Insurance Company within 31 days of termination of coverage. Conversion Form ET 2306 may be downloaded from ETF's Internet site or requested from Minnesota Life by calling (608) 277-8690.

UNIVERSITY INSURANCE ASSOCIATION (UIA) LIFE INSURANCE (Minnesota Life Insurance Company)

(Unclassified Faculty and Academic Staff only)

UW EMPLOYEES INC. GROUP LIFE INSURANCE (Minnesota Life Insurance Company)

You should know. . .

ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE (Zurich American Life Insurance Company)

You should know. . .

• A death benefit will be paid according to the beneficiary designation on file with the University of Wisconsin System.
• The death must occur within 365 days of the accident and meet qualifying plan provisions.
• The following benefits apply if you were enrolled in the Family Plan at time of death:
  
  • Your surviving spouse will be paid an additional 1% of the principal sum for 12 months in addition to any other benefits.
  • Your surviving spouse may receive a retraining benefit, within 30 months from the date of death, to a maximum of $3,500.
  • Your dependent child, if enrolled as a full-time student beyond 12th grade or in 12th grade at the time of accident, who enrolls in an accredited college, university or trade school within one year from the date of the accident, may receive an education benefit up to $2,000 for annual tuition for a maximum of four consecutive years.
    • If there are no dependent children who qualify for the education benefit, $1,000 additional benefit will be paid to the designated beneficiary.

What the survivor should do. . .

• Call the Zurich American Insurance Company at 1-866-841-4771 to report the death or dismemberment and request a claim form. Zurich must receive written notice of the covered loss within 90 days of the loss. The notice must name the covered person who sustained the injury, your name and the policy number (GTU 8364005).
• The notice should be sent to: Zurich Document Distribution Center (DDC), PO Box 968041, Schaumburg, IL 60196-8041. The dedicated claim fax number is 1-631-845-2523.
• Be prepared to provide:
  • A completed death claim form
  • A certified copy of the death certificate,
  • A copy of the motor vehicle accident report or police report,
  • A copy of the autopsy or a coroner's inquest, if performed, and
  • Any newspaper clipping(s) pertaining to the accident.

EMPLOYEE REIMBURSEMENT ACCOUNT

You should know. . .

• Money left in a your Health Care Flexible Spending Account (FSA) may be accessible after death for expenses incurred by you or a family member prior to the date of death.
• COBRA Continuation is available to your surviving spouse and dependents who were eligible to incur expenses under the employee's Health Care FSA.
• Eligible expenses incurred prior to the date of death may be reimbursable from the Dependent Care FSA.

What the survivor should do. . .

• Contact WageWorks toll free at 1-855-428-0446 for information concerning reimbursements and procedures required to file claims.
• Contact the employee's Benefits Office to apply for Continuation of Coverage for the remainder of the calendar year.

TAX SHELTERED ANNUITIES (TSA) And WISCONSIN DEFERRED COMPENSATION

Beneficiaries should contact the TSA investment company and/or the Wisconsin Deferred Compensation Program for information on distribution options and requirements.

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This document was last revised on January 3, 2013