Retiree GRS Forms










Retiree GRS Forms

Retiree GRS Forms

Retiree Optional Benefit Change Form

This form allows retirees to cancel/decrease optional benefits coverage.

Retiree Optional Benefit Qualifying Event Change Form

This form allows retirees to make changes within 31 days of a "Qualifying Event".

Retiree Direct Deposit Authorization Form

This form allows you to have your retirement benefits deposited directly into your checking, savings, or money market account for the appropriate pay period.

Withholding Certificates for Pension / Annuity Payments:

Federal W-4P

The current Federal W-4P tax form.

The completed form should be returned to the Gwinnett Retirement Services Department.

Georgia G-4P

The current State of Georgia G-4P tax form.

The completed form should be returned to the Gwinnett Retirement Services Department.

GRS Data Change Form

This form is used to update contact information such as your name, address, or phone number with the Gwinnett Retirement Services Department.

Life Insurance - MetLife Basic And Supplemental Life Insurance Designation of Beneficiary

This form allows you to designate or make changes to your basic and supplemental life insurance.

Life Insurance - MetLife Basic $15,000 Life Insurance Designation of Beneficiary

This form allows you to designate or make changes to your basic $15,000 life insurance.

Life Insurance - MetLife Supplemental Life Insurance Designation of Beneficiary

This form allows you to designate or make changes to your supplemental life insurance.

Dental - Metlife

Metlife offers a Preferred Dentist Program or PDP network to help maximize your dental benefits. By selecting a participating network dentist or specialist you increase your savings, allowing your dental benefit dollars to go further. You can obtain a list of PDP dentists on-line at www.metlife.com/mybenefits. You must enter "Gwinnett County Public Schools" for the Company Name. If you prefer, you can call 1-800-942-0854 for assistance. If you find your current dentist is not in the network, you can still continue to use the dentist of you choice. There is no penalty for not using a PDP as this is a direct reimbursement plan.

Eyemed Vision

The Eyemed Vision Plan offers a vision-care network that includes vision care providers, such has LensCrafters, Pearle Vision, Sears Optical, Target and JCPenny, and includes a network of private practitioners. Using an in-network provider allows you to receive care at no cost or minimal out-of-pocket expense. The company website is www.eyemedvisioncare.com