Survivor’s Benefit

Survivor's Beneficiary Form

Who is Eligible?

Active member or spouse.

What is the Benefit?

The Fund will pay $1000 upon the death of either the member or the member’s spouse.


Submit a certified copy of the death certificate to the Fund office along with the member’s social security number and designation of beneficiary form.


Covered members are those as defined by the Fund and include 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. Retired members, their spouses, and those on COBRA are not eligible for this benefit

The member will be the beneficiary upon the death of his or her spouse. The member’s spouse will be the beneficiary upon the death of a member unless a signed form naming another beneficiary is on file with the employee’s payroll office. Payment will be made to the designated beneficiary of single members.