Forms for Retirees

Member Mailing Address Change Form
* If you are still working for a PERSI employer, your address must be updated through your employer’s payroll transmittal.

Member Name Change Form
* If you are still working for a PERSI employer, your name must be updated through your employer’s payroll transmittal.

PERSI Durable Limited Power of Attorney Form

Release of Information Form

Request For Account Information By Spouse or Former Spouse Form

Retirement Application Kit

State of Idaho Tax Withholding Form

Third-Party Verification Request

* All other Choice 401(k) Plan forms are available by calling Empower Retirement at 1-866-437-3774 or by logging into your Choice 401(k) Plan account. You can log in to your Choice 401(k) Plan account either via the link in your myPERSI account or directly to the Choice 401(k) Plan website.

Forms for Members

Base Plan Account Withdrawal Form
* Do not submit this form until you have terminated all employment with PERSI-covered employers

Beneficiary Designation Form

Choice 401(k) Plan Paycheck Contribution Election

Member Mailing Address Change Form
* If you are still working for a PERSI employer, your address must be updated through your employer’s payroll transmittal.

Member Name Change Form
* If you are still working for a PERSI employer, your name must be updated through your employer’s payroll transmittal.

PERSI Durable Limited Power of Attorney Form

Release of Information Form

Request For Account Information By Spouse or Former Spouse Form

Retirement Application Kit
* Be sure to include a completed copy of the Federal W-4P Form with your completed Retirement Application Kit.

Social Security Quote Certification

Third-Party Verification Request

FRF 2018

10/25/18 – Sample FRF JE Employers With FYE 9-30-2018 Using 6-30-2018 Measurement Date

10/25/18 – FRF Sample Footnote For Employers With 9-30-2018 FYE Using 6-30-18 Measurement Date

10/25/18 – FRF Instructions For Sample Journal Entries, Footnote Disclosure and RSI For Employers With a 9-30-18 FYE With a 6-30-18 Measurement Date

10/25/18 – PERSI GASB 68 2018 Allocation Report FRF

10/25/18 – PERSI GASB 68 2017 Allocation Report FRF

10/25/18 – PERSI 2018 Financial Statements

10/25/18 – FRF 2018 GASB 68 Actuary Report

Insurance Vendors

Vendor Portal

School District and Charter Schools

Idaho Code 33-1228 allows eligible retirees to convert half of their unused sick leave to a sick leave account that is used to pay premiums for “group health, long-term care, vision, prescriptions drug, and dental programs as may be maintained by the employer”. Upon your retirement, your employer will provide PERSI with an accounting of your unused sick leave, and this accounting will be used to calculate the amount of unused sick leave credited to your account.

The coverage options available vary by district, so to determine the current list of insurance options available to you, you will need to contact the HR office at the employer you retired from. Once you decide on which coverage options, you are responsible for contacting the insurance carrier, enrolling in coverage, and instructing the carrier to add your name to the PERSI billing file. If you wish to change insurance plans or cancel your coverage, you must contact the insurance carrier directly. The insurance carrier will then end the deductions from your PERSI account.

State of Idaho

Idaho Code 67-5333 allows eligible retirees to convert half of their unused sick leave to an account that can be used to pay premiums for “such health, dental, vision, long-term care, prescription drug, and life insurance programs as may be maintained by the state”. Upon your retirement, your employer will provide PERSI with an accounting of your unused sick leave, and this accounting will be used to calculate the amount of unused sick leave credited to your account.

The Office of Group Insurance is responsible for entering into agreements with insurance carriers to provide coverage to the State of Idaho retirees. Once you decide on coverage options, you are responsible for contacting the insurance carrier, enrolling in coverage, and instructing the carrier to add your name to the PERSI billing file. If you wish to change insurance plans or cancel coverage, you must contact the insurance carrier directly. The insurance carrier will then end the deductions from your PERSI account. “For the list of approved carriers and contact information, visit the website of the Office of Group Insurance.”