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OHR.HITS@montgomerycountymd.gov

240-773-6471

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Dear MCG Employee and Retirees,

The Salary, Annual & Sick Leave Beneficiary form is now digital; making it easier for you to submit your beneficiary changes online without requiring the need to complete paper forms or return them to OHR manually.

TIP: Completing the form in web browser google Chrome provides the best user experience.
To complete your Life Insurance Beneficiary Form, please read the message below, check the box that you are willing to complete a digital version of the election form and proceed to complete your form online.

If you name a Trust as your beneficiary, you must upload a copy of the Trust Agreement. To upload, click on the attachment icon (paperclip) to the left or bottom of the page (depends on your web browser).

If you need assistance while completing your form on the next page, scroll down to find helpful definitions and instructions for designating your beneficiaries.

For more information about Life Insurance, please visit the Office of Human Resources (OHR) Health Insurance Webpages.

All life & health insurance questions should be directed to OHR's MC311 Customer Service Center at 240-777-0311 (Mon-Fri 8 am - 5 pm) to open a service request.  A member of the health insurance team will respond to your service request in the order it is received.  TIP: Please provide an email address at the time you place your Service Request. This will ensure the fastest response possible.

After you submit your form, you will see a pop-up message that allows you to download a copy of your form. You are strongly encouraged to download the form to keep a copy for your records.

You will also receive an email that your form has been submitted. This email acts as confirmation that your form was successfully submitted.
Please check that you agree before continuing.
By continuing I agree that I am willing to complete a digital version of the document(s) and that information about my user session will be stored.
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Copy of Trust Click Here to Upload