All participants must complete and sign a Permanent Data Form which can be obtained from the Plan Office, any MEBA Branch Office, or by downloading and printing the form below.  You must use this form to: (a) designate your beneficiary for the Life Benefit, and (b) advise the Plan of your eligible dependents. A new form must be completed if there is any change in your or your dependents' status (e.g., changes due to births, marital status, deaths, student status, address change, etc.) All completed forms should be returned directly to the Plan Office in Baltimore. Your form is valid only when you, the participant, have completed and signed it personally. You must provide us with the original--you cannot email or fax any form to us.

Permanent Data Form - (Form2).

COBRA Beneficiary Designation Form.

Dependent Parent Form.

Student Status Verification Form.

Send mail to benefits@mebaplans.org with questions or comments about this web site.
Last modified: December 18, 2007