OPEIU is pleased to announce that delegates to the OPEIU 26th Convention approved the introduction of two new membership benefits for all OPEIU members – a $2,000 life insurance benefit, and a $2,000 accidental death and dismemberment benefit.   These new benefits are being provided at no additional cost to OPEIU members. 

Both the life insurance and accidental death and dismemberment certificates are available here for download.  Once downloaded, these certificates should be kept in a safe place with other important financial documents. 

The Explanation of Basic Forms provides information for each form on this page. 

The Basic Life Enrollment Form is required in order to receive these benefits.  Please fill out this form and return to Local 537.  The following information should be included on the form.  The Policy Holder is OPEIU.  The Policy#, Plan Group is OPEIU AFL-CIO, CLC (260C92). 

Fill out this form if you want to make a Change of Beneficiary or Name. 

Request for Conversion Application is for individuals who were covered for life insurance under the group policy and who subsequently terminate employment and wish to convert to an individual life insurance policy for which they would pay their own premiums; or individuals who have attained the age or changed class and their life insurance amounts are reduced. These individuals may wish to convert to an individual policy, the part of their group coverage that was reduced. 

The insured is eligible for Waiver of Premium due to a disability caused by accident or illness before the age of 60. 

The Statement of Claim for Accidental Dismemberment Benefits, must be completed by the insured member (dismembered), and the insured physician.  Forward this claim form to Local 537. 

Notice of Death must be used for reporting claims.  It should be forwarded to Local 537, along with a Certified Death Certificate.  If you have submitted your enrollment certificates to Local 537, we will forward them, along with the Death Certificate, and Notice of Death, to the Insurance Company. 

Claimant’s Statement must be completed by all beneficiaries. There is an election box on the bottom of the back page of the Claimant’s Statement. This must be completed for all claims. Further details will be provided to the beneficiary regarding the Secure Benefits Account if elected. Please note: This is a two sided form. 

A Survivors Affidavit should be completed by the administrator, spouse, children, parents, brother or sister of the deceased to determine the first preferential beneficiary in cases where there is no named beneficiary form.

In order to receive these benefits, you must be a member in good standing with OPEIU with 12 or more consecutive months of membership.  A member’s good standing and eligibility is forfeited if the member is more than 2 months in arrears in Dues during the 14 month period prior to death, exclusive of the month of death.