Beneficiary Information

What is a Beneficiary?

A beneficiary is the person or entity named in a life insurance policy, retirement plan or health savings account. This is the person that receives the benefit upon death. The beneficiary designation on file at the time of death is binding in the payment of your benefits.

Whenever you have a life event, such as a marriage, divorce or birth of a child, review and update your beneficiary designations. Beneficiary designations can be changed at any time.

The forms can be found below. Send completed forms directly to the benefit plan vendor (not to the human resources office). The appropriate address can be found on each form.

Retain a copy of the beneficiary designation forms for your records (the UW System does not process or retain the forms).

If a beneficiary is not designated, benefits will be paid according to Wisconsin law. This is called Standard Sequence and will pay as follows:

  • Employee’s surviving spouse, otherwise;
  • Employee’s surviving children equally, otherwise;
  • Employee’s surviving grandchildren equally, otherwise;
  • Employee’s surviving parents equally, otherwise;
  • Employee’s surviving siblings equally, otherwise;
  • Employee’s estate.

All claims associated with the death of a covered family member will be paid to the employee.

Plans with Beneficiary Designations

Wisconsin Retirement System (WRS), State Group Life Insurance, and accident insurance

WRS, State Group Life Insurance and Accident Insurance share the same beneficiary designations. Employees have the option to complete one of two forms.

  • Beneficiary Designation Form (ET-2320) pdf allows you to name primary, secondary and tertiary beneficiaries.
  • Beneficiary Designation (alternate) Form (ET-2321) pdf allows you to name primary and secondary beneficiaries and/or successors to those beneficiaries.
  • Mail completed form to: Department of Employee Trust Funds, P.O. Box 7931, Madison, WI 53707-7931.
  • To name different beneficiaries for these plans, complete separate forms and specify which plan it applies to on the form.

State Group Life Insurance Policy Number: 2832-G
Accident Insurance Policy Number: 76038

Individual & Family Life Insurance

Once enrolled, beneficiary forms can be made by paper.

Group Policy Number: 32871-G

UW Employees, Inc. Life Insurance

Once enrolled, beneficiary designations can be made online or by paper.

  • Once you enroll in coverage, Securian will send you login information so you can name your beneficiary online through the secure LifeBenefits portal OR
  • Beneficiary Designation Form pdf
    • Mail to: Securian Financial Group, Inc., PO Box 259708, Madison, WI 53725-5708 or
    • Fax to: (608) 277-8665

Group Policy Number: 33977-G

University Insurance Association (UIA) Life Insurance

Once enrolled, beneficiary designations can be made by paper.

Group Policy Number: 32872-G

Accidental Death & Dismemberment (AD&D) INSURANCE

Once enrolled, beneficiary designations can be made by paper.

Group Policy Number: GTU 8364005

*For annuitants who continued their AD&D Insurance coverage after retirement, mail the completed beneficiary form to the plan broker: Hausmann-Johnson Insurance, P.O. Box 259408, Madison, WI 53725-9408

Accident Insurance

Accident Insurance, WRS, and State Group Life Insurance share the same beneficiary designations. Employees have the option to complete one of two forms.

  • Beneficiary Designation Form (ET-2320) pdf : Allows you to name primary, secondary and tertiary beneficiaries.
  • Beneficiary Designation (alternate) Form (ET-2321) pdf : Allows you to name primary and secondary beneficiaries as well as successors to those beneficiaries.
  • Mail completed form to: Department of Employee Trust Funds, P.O. Box 7931, Madison, WI 53707-7931.
  • To name different beneficiaries for these plans, complete separate forms and specify which plan it applies to on the form.

Accident Insurance Policy Number: 76038

Health Savings Account (HSA)

Beneficiary designations can be made online or by paper.

  • Once enrolled you can name your beneficiary online with Optum / ConnectYourCare (CYC) through their portal OR
  • HSA Beneficiary Form pdf
    • Mail completed form to: ConnectYourCare, P.O. Box 85960, 6300 Wayne Road, Westland, MI 48185

UW 403(b) Supplemental Retirement Program (SRP)

Contact your 403(b) reconrdkeeper(s) to obtain a beneficiary designation form.

Fidelity, T. Rowe Price and TIAA participants can update beneficiary designations through their online account.

Current Recordkeeper Contact Information:

Frozen Recordkeeper Contact Information:

Wisconsin Deferred Compensation (WDC) 457 PROGRAM

The recordkeeper for the Wisconsin Deferred Compensation (WDC) program is Empower Retirement. Beneficiary designations can be made online or by paper.

  • Once enrolled, a password is mailed to the address on file. Use your social security number (username) and this password to access your account online at www.wdc457.org.
  • Beneficiary Designation Form pdf – A paper designation form can be mailed directly to Empower Retirement, P.O. Box 173764, Denver, CO 80217-3764 or fax to (866) 745-5766.

         Contact Information:

 Resources

Every effort has been made to ensure this information is current and correct. Information on this page does not guarantee enrollment, benefits and/or the ability to make changes to your benefits.

Updated: 06/22/2021