Retiree Forms
All change to retiree benefits must be done in writing, using one of the forms below: All forms must be submitted to the Risk & Benefits Department by the 7th of the month to assure proper timely enrollment/cancellation. Cancellation forms submitted after the 7th of the month will be still be accepted; however, deductions for the next month’s premiums cannot be stopped. Once the benefit payments have been posted, a refund can be issued. Refunds may take 30 days from the date payments are posted for the following month
ACH Deduction Authorization Form
Retiree must complete this form if you are changing banks and your benefit deductions are currently deducted from your personal bank account each month
Retiree Benefit Cancellation Form
Retiree must complete this form if you want to cancel any current retiree benefit
Life Insurance Beneficiary Form
Retiree may complete a new beneficiary form any time they wish to change beneficiaries.
MCSD Health Insurance Subsidy Enrollment Form
Retiree, with a minimum of 15 years of service, and cancelling their medical insurance with the District, must complete to be eligible to continue to receive the monthly subsidy once they cancel their medical insurance.
Florida Blue Medicare Advantage Application
Retiree, becoming Medicare eligible, may enroll in the Florida Blue Medicare Advantage plan by completing the application.
Cigna Medicare Supplemental Plan G Application
Retiree, becoming Medicare eligible, may enroll in the Cigna Supplemental plan G plan by completing the application.