ABOUT THE PLAN
  Features & Benefits
  Facts About the Plan
  Schedule of Benefits
  Want to Participate?

FOR EMPLOYERS
  Eligibility
  Employer FAQ's
  Administration Manual
  Electronic Billing & Pmts.
  Update Unit Info
  Enrollment
  Filing a Claim
  Forms
  Non-Participating Groups
  Open Enrollment

FOR MEMBERS
  Eligibility
  Member FAQ's
  Schedule of Benefits
  What if I'm disabled?
  Enrollment
  Filing a Claim
  Forms

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NON-PARTICIPATING GROUPS

Employers who do not currently offer the NCPERS Group Life Insurance program to their employees and would like to can complete the following form.

American Administrative Group will send you enrollment instructions, sample introductory letter and a supply of enrollment brochures for your employees .

Employer Unit Information

Complete and submit this form.

IMRF Unit #:
Name of Employer
Enrollment Contact:
Billing Contact:
Mailing Address 1:
Mailing Address 2:
City:
State: ZIP:
Phone:
Fax:
Email:
# of Eligible Employees: