The completed form must be sent to the insurer for approval (along with copies of all enrollment forms, beneficiary changes, and absolute assignments) in any of the following situations:
- If the designation differs from the examples on the reverse side of the form,
- If the coverage has been assigned,
- If the previous beneficiary was irrevocable, or
- If the insurer maintains all the beneficiary designation records for your plan (including all individual policies).
|Form Name||Form Number|
7384w (114834) (rev 9/01/14)
47716f (116371) (rev 9/01/14)