Beneficiary Designation

Introduction

If you participate in one of the benefit plans listed below, you have the option to designate who will receive payments in the event your death, or where applicable, the death of an insured spouse, domestic partner or dependent. Please see your recent earning statements, found at My UW under the Work Record tab, to review your benefit plan participation.

If you do not elect to designate beneficiaries, or if your designated beneficiaries are deceased, there is a default sequence of beneficiaries, known as a “standard sequence.”  The standard sequence describes the order of which survivor receives payments upon the death of the insured person.  The standard sequence for all benefit plans is listed below:

  • Employee Coverage, Standard Sequence:
    1. Your spouse / domestic partner, if living; otherwise
    2. your children equally, with the share of any deceased child payable to the issue of the child or, if there is no surviving issue of a deceased child, to the other eligible children in this group or, if deceased, their issue; otherwise
    3. your surviving parents equally; otherwise
    4. your siblings equally, and the issue of any deceased sibling; otherwise
    5. your estate.
  • Spouse / Domestic Partner and Dependent Coverage, Standard Sequence:
    1. You, if living; otherwise your estate.

If you want to designate your beneficiaries, please complete the appropriate form and mail it to the address provided on the form.

Note:  If you participate in the Tax Sheltered Annuities (TSA) 403(b) program, please contact your investment company for standard sequence information and to obtain a beneficiary designation form. | TSA Investment Companies Contact Information

Please retain a copy of your beneficiary designation forms for your records.  UW-Madison Benefit Services does not process, store or have access to beneficiary designation forms.  Please contact the benefit plan administrators directly for information regarding your beneficiary designations. | Benefit Plan Contact Information

Beneficiary Designation Forms

EPIC Benefits+
Plan Document | Group Number: 3180

Note: You, the insured employee, cannot name beneficiaries for the EPIC Accidental Death and Dismemberment benefit for spouse / domestic partner and dependent coverage. You are the only beneficiary.

Beneficiary Designation Form
Mail to: EPIC Life Insurance Company,
P.O. Box 8430, Madison, WI 53708-8430
or Fax to: 1-800-236-7610

Individual Family and Group Life Insurance
Plan Document | Policy Number: 32871-G

Beneficiary Designation Form
Mail to: University of Wisconsin System, Human Resources,
780 Regent Street, Suite 305, Madison, Wisconsin 53715

University Insurance Association Life Insurance (UIA)
Plan Document | Policy Number: 32872-G

Beneficiary Designation Form
Mail to: Minnesota Life Insurance Company,
P.O. Box 259708, Madison, WI 53725-9708

UW Employees, Inc. Life Insurance
Plan Document | Group Policy Number: 46

Beneficiary Designation Form
Mail to: Minnesota Life Insurance Company - A Securian Company
Group Administration Department
400 Robert Street North, St. Paul, MN 55101-2098

Accidental Death and Dismemberment Insurance (AD&D)
Plan Document | Policy Number: GTU 8364005

Note: You, the insured employee, cannot name beneficiaries for the Accidental Death and Dismemberment benefit for spouse / domestic partner and dependent coverage. You are the only beneficiary.

Beneficiary Designation Form
Submit this form to your Payroll and Benefits Office; the form will be submitted to the benefit plan for processing.

State Group Life Insurance and Wisconsin Retirement System (WRS)
State Group Life Plan Document | WRS Plan Document

These two benefit plans use the same Beneficiary Designation Form.  If you want the beneficiary designation to apply to specific benefit plan(s) or account(s), use the space at the bottom of the form to specify the benefit plan(s) or account(s) to which you want the designation to apply.  See the “Effective for all benefit plans and accounts” section of the instructions before completing this section of the form.

Beneficiary Designation Form
Alternate Beneficiary Designation Form
Mail to: Wisconsin Department of Employee Trust Funds,
P.O. BOX 7931, Madison, WI 53707-7931

Tax Sheltered Annuities (TSA) Contact Information

If you participate in the Tax Sheltered Annuities (TSA) 403(b) program, please contact your investment company for standard sequence information and to obtain a beneficiary designation form. If you have a Fidelity, T. Rowe Price, or TIAA-CREF investment account, you may update your beneficiary designation through your online account page.

Wisconsin Deferred Compensation (WDC)
Plan Document

Beneficiary Designation Form
Mail to: Great-West Retirement Services,
P.O. Box 173764, Denver, CO 80217-3764
or use the express mail address:
Great-West Retirement Services,
8515 E. Orchard Road, Greenwood Village, CO 80111
or Fax to: (866) 745-5766