Beneficiary Designation Forms

Beneficiary Designation Form

This form should be completed by the member to change beneficiary designation for MESSA life insurance. Complete the Non-Negotiated Life Insurance section of the form if you have Basic Term Life or Supplemental Term Life. Complete the Negotiated Life Insurance section if you have PAK Life or Negotiated Life insurance. If you have both Non-Negotiated and Negotiated Life Insurance, please complete both sections of the form. Please fill out completely, sign and return to MESSA Group Services.

Beneficiary Designation Form FAQs
Instructions on Completing Your Beneficiary Designation Form

1475 Kendale Blvd., P.O. Box 2560, East Lansing, MI 48826