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

HOME

NON-PARTICIPATING GROUPS

Employers who do not currently offer the PERSI/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.

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