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This form is to be used by retirees or those on long-term disability to update their benefit coverage options, including medical, dental, and vision plans in the state of Arizona.
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How to fill out STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD ENROLLMENT FORM 2012

01
Obtain the STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD ENROLLMENT FORM 2012 from the official Arizona state website or HR department.
02
Read the instructions carefully to understand the eligibility and benefits being offered.
03
Fill in your personal information in the designated fields, such as name, address, and contact information.
04
Provide your social security number and employee identification number as requested.
05
Indicate your choice of benefits by checking the appropriate boxes for health insurance, dental, and vision plans.
06
If applicable, fill out any additional sections regarding dependents, including their names and dates of birth.
07
Review the completed form to ensure all information is accurate and nothing is omitted.
08
Sign and date the form at the bottom before submitting it as instructed.

Who needs STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD ENROLLMENT FORM 2012?

01
Retired employees of the State of Arizona who are eligible for benefits.
02
Former employees enrolled in Long-Term Disability (LTD) who are transitioning to retiree status.
03
Individuals needing to enroll or make changes to their benefit options upon retirement.
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People Also Ask about

Your ASRS retirement pension provides a lifetime guaranteed benefit based on your years of service and final salary. You have a contractual relationship with the ASRS, protected by the Arizona constitution.
Your ASRS retirement pension provides a lifetime guaranteed benefit based on your years of service and final salary. You have a contractual relationship with the ASRS, protected by the Arizona constitution.

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The STATE OF ARIZONA BENEFIT OPTIONS RETIREE/LTD ENROLLMENT FORM 2012 is a document used by eligible retirees and individuals on long-term disability to enroll in the state's benefit options for health care and other benefits.
Eligible retirees who are transitioning from active employment to retirement, as well as individuals who are on long-term disability, are required to file this form to maintain or enroll in benefit options.
To fill out the form, individuals must provide personal information, select benefit options, and ensure all required sections are completed accurately before submitting the form by the specified deadline.
The purpose of the form is to facilitate the enrollment process for retirees and individuals on long-term disability in the state benefit programs, ensuring they have access to health and other benefits.
The information required includes the individual's personal details, retirement date, selections for health insurance and other benefits, as well as any dependents that may also need coverage.
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