Bereavement Beneficiary Form

Who is Eligible?

Active Members Only and Active College Aides.

What is the Benefit?

A death benefit in the amount of $10,000 (prior to 1/1/2021), or $25,000 (after 1/1/2021), is payable to the beneficiary or beneficiaries named in writing by the member and filed with the member’s payroll representative. If no beneficiary is named, or if a named beneficiary is not living at the time of the member’s death, payment will be made to the member’s estate. Please note that the Benefit is reduced by half when the deceased is over 70 years of age.


Covered members are those as defined by the Fund in an active payroll status only, with the exception of those members on a leave of absence of up to one year due to extended illness, maternity, or a job-related injury resulting in Worker’s Compensation status or Suffolk County Community College Aides.

Retired members or members on COBRA are not eligible for this benefit.


A copy of the original death certificate, with cause of death and the issuing municipality’s seal must be submitted to the Fund office along with the member’s social security number.

In those cases where no beneficiary has been named or the named beneficiary predeceased the member, copies of Letters of Administration or Letters Testamentary from the Surrogate Court must also be submitted.

Designating a Beneficiary

Designation of Beneficiary Forms are filed and kept with your departmental payroll representative. If you wish to update information, complete another form at that time. This information will supersede the original form.