Basic Life Insurance Claim Submission When an active employee or retiree who is covered by a PEBP Plan passes away, they may be entitled to a basic life insurance benefit. To initiate the life insurance claim process, please complete the “Claimant’s Statement” on page one of the “Life Claim Form.” You may also wish to complete the “Claims Department Direct Deposit Agreement For Payment of Benefit to Financial Institution” section on the last page of the claim form if you wish to receive any applicable benefit by direct deposit. Once you have completed the required claim form, please submit it to the PEBP office along with a copy of the certified death certificate (you do not need to send the original). Once the claim has been received, PEBP will complete the “Employer’s Statement” on page two of the claim form to determine eligibility and submit the form along with the death certificate to PEBP’s basic life insurance administrator, UHC, for processing. If an additional voluntary life insurance benefit is identified, PEBP will submit the required form and documentation to our voluntary life insurance administrator The Standard. All life insurance claims require review to ensure eligibility in compliance with the PEBP master plan documents.
Please note: Adjustments in premiums resulting from the death of a covered participant or dependent will be refunded if notification of death is received within 60 days of the participant’s or dependent’s date of death. Notification of death beyond the 60-day period will not be refunded.
Survivor Benefits Eligible surviving dependent(s) who wish to continue coverage under PEBP must complete an enrollment election by submitting the required form to PEBP within 60 days of the date of death of the employee or retiree. Surviving dependents include a participant’s spouse or domestic partner and dependent children to age 26 years (or to age 19 years for child(ren) under permanent legal guardianship) who are covered under the participant’s medical Plan on the date of the participant’s death. If the decedent was an active employee (not a retiree), they must have at least 10 years of services at time of death for the surviving dependents to be eligible. To apply for survivor benefits, please complete the Retiree Benefit Enrollment and Change Form (RBECF) at
https://pebp.nv.gov/Resources/forms/forms/ and select the option for “Survivor Election”. Rates for survivor benefits are unsubsidized and enrollees are responsible to pay for the full cost of premiums for their coverage and insurance to PEBP. Survivor benefits will initiate on the first day of the month following the participant's death dependent on submission of required forms and eligibility requirements.