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Interest Survey: Affiliate for Optional Life Insurance Coverage (Fall 2026)
Confirm affiliation and provide employer information.
*
1.
Confirm you want to affiliate for member, spouse and child optional insurance coverage.
(Required.)
Yes. My employer wants to affiliate for optional life insurance, which includes member, spouse and child coverage.
No. My employer does not want to offer optional life insurance to employees.
*
2.
Contact Information
(Required.)
Your Name:
Email Address:
Employer Name:
KPERS Employer Number:
