Minnesota News

Reinstate Taxable Life Insurance

Use this form to reinstate your state-paid life insurance coverage above $50,000.

Qualifying Status Change Form

To add/drop dependents to medical and dental coverages for life events outside of Open Enrollment.

HSA Change in Contribution Form

Use this form to change your annual HSA contribution amount.

Request to Waive Taxable Life Insurance Coverage

The value of state-paid life insurance coverage over $50,000 is taxable income. Use this form to waive any coverage above $50,000.

Grandchild Certification form

Form used to certify the eligibility of your grandchild.

Foster Child Certification Form

Form used to certify the eligibility of your foster child or ward.

Spouse Certification Form

Certification form for spouses.

Post-Retirement Option

Agencies may develop post-retirement positions to provide non-permanent employment to retirees in order to complete project work or other work of a short-term nature. Before extending an offer of a post-retirement position, state agencies must first verify that the individual meets all eligibility criteria for the position. Eligibility for compensation and benefits is determined by each individual post-retirement agreement. Individuals hired for a post-retirement position may qualify for insurance benefits, and agencies must closely review eligibility.

Pre-Tax Forms & Applications

This link takes you to the BRI landing page where you'll find forms to enroll in and make changes to pre-tax spending accounts.

Post Retirement Application - Optional Life Insurance (Spouse)

For retirees age 65 and older to convert their Employee Additional Life Insurance into the 20% paid-up policy. You should include this form with your Continuation of Coverage application upon Retirement or Special Retirement.