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Scheduling Your Retirement Out-Processing Meeting (City of Plano)

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Scheduling Your Retirement
Out-Processing Meeting
Once you have your finalized retirement date and given your resignation letter to your
department, please contact your Senior Human Resources Analyst at 972.941.7115 to
schedule your retirement out-processing. This meeting will need to be scheduled
around 30 - 60 days prior to your retirement date.
The meeting will take approximately 1 hour. Below are items you will need to bring with
you to the meeting:
Driver’s license
Copy of spouse’s driver’s license
Voided check
Beneficiary information to include:
Name
Social Security number
Address
Date of birth
Medicare card, if applicable
Proof of birth
City of Plano
City of Plano
Human Resources Analyst
MEMBER INFORMATION
Please type or use only black or blue ink and do not highlight. Any corrections must be initialed.
Member’s Name (first, middle, last) TMRS ID Number (not required) Social Security Number
Mailing Address City State Zip Daytime Phone Number
MARITAL STATUS (must check one): q Married q Not married (If married, see Spousal Consent section
z
below.)
PRIMARY BENEFICIARY DESIGNATION Limit 3 Please read instructions carefully. If desired, alternate beneciary designations may be
completed on page 2. For more information about designating custodians for minors (under 21), please see the attached instructions.
Beneficiary’s Full Name (first, middle, last) Social Security Number
q Male q Female • Relationship: q Spouse q Non-Spouse
Date of Birth (MM/DD/YYYY)
Custodian’s Name if beneficiary age under 21 (optional) Custodian’s Relationship to Beneficiary
Beneficiary’s Full Name (first, middle, last) Social Security Number
q Male q Female • Relationship: q Spouse q Non-Spouse
Date of Birth (MM/DD/YYYY)
Custodian’s Name if beneficiary age under 21 (optional) Custodian’s Relationship to Beneficiary
Beneficiary’s Full Name (first, middle, last) Social Security Number
q Male q Female • Relationship: q Spouse q Non-Spouse
Date of Birth (MM/DD/YYYY)
Custodian’s Name if beneficiary age under 21 (optional) Custodian’s Relationship to Beneficiary
RETIREMENT OPTIONS Please read instructions before completing, and check only one box.
Retiree Life Only Benefit (up to 3 beneciaries) Retiree Life – Survivor Benefits (only 1 beneciary) Retiree Life – Guaranteed Term Benefits (up to 3 beneciaries)
q q 100% q 75% q 50% q 5 yr q 10 yr q 15 yr
MEMBER SIGNATURE REQUIRED
•
Making false or misleading statements on any form submitted to TMRS is a violation of State law and has criminal and
potential civil liability. For this account only, I hereby revoke all prior beneficiary designations. I direct TMRS to pay, after I die, all of my TMRS benefits for this account (including
Supplemental Death Benefit (SDB), if any) to the beneficiary(ies) listed on this form. If a beneficiary dies, or I divorce a beneficiary (and I have not chosen a Retiree Life-Survivor option),
then this designation becomes void for that person. If I name more than one beneficiary, my benefits will be divided equally among surviving primary beneficiaries, unless otherwise
stated. I understand that if I or my designated beneficiary(ies) should die before recovering the amount of the accumulated deposits and interest in my individual account at the time of
retirement (reduced by any partial lump sum distribution taken), the remaining balance will be paid to my estate or beneficiary.BY SIGNING THIS FORM, I CERTIFY THAT I HAVE READ THE
ATTACHED INSTRUCTIONS, MY MARITAL STATUS IS CORRECT, AND ALL OF THE INFORMATION I HAVE PROVIDED IS CORRECT.
Member’s Signature Date Signed (MM/DD/YYYY)
SPOUSAL CONSENT only to be completed for certain cases, see below
Your spouse must complete this section in front of a notary only if you are married and if one of the following scenarios apply:
■
You choose a Retiree Life –Survivor Benet (100%, 75%, or 50%) option and your spouse is not designated as your only primary beneciary; or
■
You choose a Retiree Life – Guaranteed Term (5-year, 10-year, or 15-year) option; or
■
You choose the Retiree Life Only Benet option.
I understand that I may require my spouse to name me as a beneciary under a Survivor Life benet. Nevertheless, I hereby consent to the beneciary(ies) designated and
the retirement option selected.
Spouse’s Printed Name Spouse’s Signature
State of County of
This instrument was acknowledged before me on the day of
, 20 ,
by
Name of Spouse
Notary Public, State of
(Name of State)
Please read the information provided on the following pages.
TMRS • P.O. Box 149153 • Austin, Texas 78714-9153 • 800.924.8677 • 512.476.7577 • FAX 512.476.5576 • www.tmrs.com *TMRS0024*
TMRS 0024 • Revised 5-2017
TMRS • Page 1
(SEAL
)
u
v
w
x
y
⊲
⊲
⊲
Selection of Retirement Plan
z
®
PURPOSE
This form allows you, to make your beneficiary designation and select your retirement option at the time of retirement.
■
This beneficiary designation only applies to the account you are intending to retire from.
■
Your beneficiary designation is eective immediately and revokes all previous beneficiary designations even if your retirement does not
become eective.
DESIGNATING YOUR BENEFICIARY
■
The number of beneficiaries you can designate will depend on the retirement option you select.
■
You may designate up to three primary beneficiaries and up to three alternate beneficiaries if you have selected either the Retiree Life
Only Benefit or one of the Retiree Life - Guaranteed Term Benefits.
■
Unless directed otherwise in writing on this form, your benefits will be paid equally to the surviving primary beneficiaries, or equally to
the surviving alternate beneficiaries, only if the designation with respect to each primary beneficiary is revoked by divorce (if designated
as a spouse on the form) or death. Contact TMRS for instructions on how to provide for unequal distributions.
■
If you desire to designate alternate beneficiaries, you must complete pages 1 and 2 of this form and submit both pages. TMRS will not
accept page 2 without page 1.
EXPLAINING YOUR RETIREMENT OPTIONS
RETIREE LIFE ONLY BENEFIT - A retirement benefit payable monthly as long as you live. Upon your death all payments will cease, even though
you may have received only one monthly payment. You can change your beneficiary designation at any time. You may designate up to three primary
beneficiaries and up to three alternate beneficiaries. If you die prior to having recovered the amount of accumulated contributions and interest in
your individual account at the time of retirement (reduced by any partial lump sum distribution to you), the remaining balance will be paid to your
beneficiary(ies) or estate.
RETIREE LIFE – SURVIVOR BENEFITS - A retirement benefit payable monthly as long as you live. At your death, your beneficiary will receive a
percentage of the benefit (possible percentages below). ONLY 1 beneficiary may be designated and you cannot change your beneficiary after your
eective retirement date (unless your beneficiary dies before you and you remarry— please call TMRS directly for more information). If you and
your designated primary beneficiary die prior to having recovered the amount of accumulated contributions and interest in your individual account
at the time of retirement, the remaining balance will be paid to your alternate beneficiary(ies) or your estate. If you elect to receive a partial lump
sum distribution on the eective date of your retirement, your remaining balance will be reduced by the same dollar amount.
■
100% - A retirement benefit payable monthly as long as you live. At your death, your beneficiary will receive 100% (the full amount) of
the monthly benefit for as long as he or she lives. If your beneficiary dies before you, the monthly payments you receive after that will
be increased to the amount that would have been payable as a Retiree Life Only Benefit. Due to IRS regulations, members may not be
eligible to select the 100% Retiree Life Survivor Benefit if they designate a non-spouse beneficiary who is more than 10 years younger
than the member.
■
75% - A retirement benefit payable monthly as long as you live. At your death, your beneficiary will receive 75% (three-fourths) of the
monthly benefit for as long as he or she lives. If your beneficiary dies before you, the monthly payments you receive after that will be
increased to the amount that would have been payable as a Retiree Life Only Benefit. Due to IRS regulations, members may not be
eligible to select the 75% Retiree Life Survivor Benefit if they designate a non-spouse beneficiary who is more than 19 years younger
than the member.
■
50% - A retirement benefit payable monthly as long as you live. At your death, your beneficiary will receive 50% (one-half) of the
monthly benefit for as long as he or she lives. If your beneficiary dies before you, the monthly payments you receive after that will be
increased to the amount that would have been payable as a Retiree Life Only Benefit.
RETIREE LIFE – GUARANTEED TERM BENEFITS - A retirement benefit payable monthly as long as you live. However, should you die before
the expiration of the designated period (possible terms below) after the date of retirement, your designated beneficiary will receive the same
monthly benefit for the balance of the designated period, then all payments cease. You may designate up to three primary beneficiaries and up to
three alternate beneficiaries and you can change your beneficiary designation at any time.
■
5 yr - A retirement benefit payable monthly as long as you live. However, should you die before the expiration of a 5-year period after
the date of retirement, your designated beneficiary will receive the same monthly benefit for the balance of the 5-year period, then all
payments cease.
■
10 yr - A retirement benefit payable monthly as long as you live. However, should you die before the expiration of a 10-year period after
the date of retirement, your designated beneficiary will receive the same monthly benefit for the balance of the 10-year period, then all
payments cease.
■
15 yr- A retirement benefit payable monthly as long as you live. However, should you die before the expiration of a 15-year period after
the date of retirement, your designated beneficiary will receive the same monthly benefit for the balance of the 15-year period, then all
payments cease.
SPECIAL INSTRUCTION: Completion of this section is optional. If completed, page 2 must accompany
page 1 when submitted to TMRS.
MEMBER INFORMATION • Please type or use only black or blue ink and do not highlight. Any corrections must be initialed.
Member’s Name (first, middle, last) TMRS ID Number (not required) Social Security Number
DESIGNATING AN ALTERNATE BENEFICIARY LIMIT 3 Please read instructions before completing. Unless otherwise specied, benets will
be divided equally among surviving alternate beneciaries, only if the designation with respect to each primary beneciary designated on page 1 of this form is revoked
by reason of divorce (if designated as a spouse on the form) or death.
Beneficiary’s Full Name (first, middle, last) Social Security Number
q Male q Female • Relationship: q Spouse q Non-Spouse
Date of Birth (MM/DD/YYYY)
Custodian’s Name if beneficiary age under 21 (optional) Custodian’s Relationship to Beneficiary
Beneficiary’s Full Name (first, middle, last) Social Security Number
q Male q Female • Relationship: q Spouse q Non-Spouse
Date of Birth (MM/DD/YYYY)
Custodian’s Name if beneficiary age under 21 (optional) Custodian’s Relationship to Beneficiary
Beneficiary’s Full Name (first, middle, last) Social Security Number
q Male q Female • Relationship: q Spouse q Non-Spouse
Date of Birth (MM/DD/YYYY)
Custodian’s Name if beneficiary age under 21 (optional) Custodian’s Relationship to Beneficiary
MEMBER SIGNATURE REQUIRED
If you complete any part of page 2, your signature is required on both pages 1 and 2.
I acknowledge that I am signing this form again, on this page 2, because I have elected to name an alternate beneficiary(ies) in addition to my primary beneficiary(ies). If I name more
than one primary or alternate beneficiary, my benefits will be paid to the surviving primary beneficiaries in equal shares (unless I have otherwise directed on this form) or in equal shares
to the surviving alternate beneficiaries if I am not survived by any primary beneficiary(ies). If a beneficiary dies, or I divorce a beneficiary (and I have not chosen a Retiree Life-Survivor
option), then this designation becomes void for that person. BY SIGNING THIS FORM, I CERTIFY THAT I HAVE READ THE ATTACHED INSTRUCTIONS, MY MARITAL STATUS IS CORRECT, AND ALL OF
THE INFORMATION I HAVE PROVIDED IS CORRECT.
Member’s Signature Date Signed (MM/DD/YYYY)
Please read the information provided on the following pages.
TMRS • P.O. Box 149153 • Austin, Texas 78714-9153 • 800.924.8677 • 512.476.7577 • FAX 512.476.5576 • www.tmrs.com
TMRS 0024 • Revised 5-2017
TMRS • Page 2
{
|
}
⊲
⊲
⊲
Alternate Beneficiary Section (optional)
SPOUSAL CONSENT
Spousal Consent is only needed if you are married and if one of the following scenarios apply:
■
You choose a Retiree Life –Survivor Benefit (100%, 75%, or 50%) option and your spouse is not designated as your only primary
beneficiary; or
■
You choose a Retiree Life – Guaranteed Term (5-year, 10-year, or 15-year) option; or
■
You choose the Retiree Life Only Benefit option.
ESTATE, TRUST, AND CHARITY DESIGNATIONS
■
If you wish to designate your estate as beneficiary, please write only the word “ESTATE” in the space provided for the name of the
beneficiary. The Retiree Life-Survivor Benefit (100%, 75%, or 50%) is not an option with an Estate beneficiary. IRS regulations may
require TMRS to distribute payments to an Estate within 5 years.
■
If you wish to designate a charity as beneficiary, please write the name of the charity (i.e., American Heart Association) in the space
provided for the name of the beneficiary. The Retiree Life-Survivor Benefit (100%, 75%, or 50%) is not an option with a charity beneficiary.
■
If you wish to designate a trust, please write “Trustee of the (enter name of trust here)” in the space provided for the name of the
beneficiary. Please ensure that you have a legal trust agreement in place prior to designating a “Trust” on this form.
■
TMRS will accept the designation of a Trust. However, we cannot assure that if and when a benefit becomes payable from TMRS, the designation
will be legally valid. In other words, if the trustee does not accept or has died, or if the trust has been revoked, or if for any other reason the
designation is not legally sucient at the time of the member’s death, the benefit due from TMRS will be paid in accordance with the provisions
of the TMRS Act as if no trust/trustee had been designated.
■
The Retiree Life-Survivor Benefit (100%, 75%, or 50%) is not an option with a trust beneficiary, where the trust has more than one beneficiary.
A trust that may be revoked is not a ‘designated beneficiary’ under the Internal Revenue Code, and may not receive retirement system benefit
payments for a period longer than 5 years.
IMPORTANT: SUPPLEMENTAL DEATH BENEFITS (SDB)
■
If your employer provides Supplemental Death Benefits (SDB) for retirees, and you are retired at the time of your death, TMRS will pay
a one-time lump sum payment of $7,500. If eligible, your beneficiary will only receive one Supplemental Death Benefit based on your
status as an active employee or a retired member at the time of your death. If your employer provides Supplemental Death Benefits
(SDB) and you die while employed, TMRS will pay a one-time lump sum payment approximately equal to one year’s salary based on the
12 months prior to death.
■
The SDB payment will be paid to the beneficiary(ies) designated on this form, even if you have previously designated a dierent SDB
beneficiary.
■
If you wish to designate a dierent beneficiary(ies) other than the person(s) designated on this form to receive the SDB payment, you
will need to complete and submit the Supplemental Death Benefits Beneficiary Designation form at the same time or after you submit
this form.
RULES FOR DESIGNATING MINOR CHILDREN
Chapter 141 of the Texas Property Code is the Texas Uniform Transfers to Minors Act (TUTMA), which allows you to nominate a “custodian” to receive
TMRS benefits on behalf of your minor beneficiary. If you wish to designate a minor (under 21) child, please write the full name and all information
pertaining to the minor child in the “Primary Beneficiary” or “Alternate Beneficiary” section of the form. Then complete the custodian information
next to each child’s name.
■
Only adults at least 21 years of age, financial institutions, corporations, or other legal entities may serve as custodians.
■
You cannot nominate two or more custodians to serve jointly for a single beneficiary. However, you may nominate a substitute custodian
to serve in the event the first nominated custodian dies before any payment is made, declines, or is ineligible to serve. Please contact
TMRS for instructions on how to nominate a substitute custodian.
■
If the same custodian is named for all minors, that custodian would receive separate benefit payments for each minor.
■
When the minor beneficiary reaches age 21, the custodianship for that beneficiary is terminated and any TMRS benefits that become
payable will be paid directly to that beneficiary.
■
The designated custodian can select any benefit option that the minor could select if the minor were an adult.
■
The minor’s Social Security number is used for IRS reporting purposes.
TMRS WILL NOT ACCEPT
■
Attachments (listing additional beneficiaries)
■
Alterations without being initialed
■
An incomplete form or any attempt to change its pre-printed provisions
■
A n unacceptable designation
GOVERNING LAW
In the event of an irreconcilable conflict between the terms of this form and the terms of the laws and rules governing TMRS, the laws and rules
shall control.
Selection of Partial Lump Sum Distribution
MEMBER INFORMATION
Please type or use only black ink and do not highlight. Any corrections must be initialed.
TMRS Identification Number (not required)
Member’s Name (first, middle, last) Social Security Number
Mailing Address Daytime Phone Number
City State Zip
PARTIAL LUMP SUM DISTRIBUTION PLSD SELECTION
The Partial Lump Sum Distribution I elect is the amount of the Retiree Life Only* benefit multiplied by (Please check only one box):
12
24
36
* The Retiree Life Only benefit is used here only to calculate the amount of your Partial Lump Sum Distribution.
You can select any of the seven retirement options for retirement purposes (see the Selection of Retirement Plan form).
NOTE: The amount of your Partial Lump Sum Distribution cannot be more than 75% of your account balance.
I choose to have my PLSD distributed as follows:
Direct Payment to Member
I want the entire Partial Lump Sum Distribution (less 20% withholding) paid directly to me.
NOTE: The IRS may require you to pay a 10% tax penalty, in addition to regular federal income tax, on your Partial Lump Sum Distribution.
You may wish to consult with a tax advisor or the IRS to determine your potential liability.
Direct Rollover to IRA/Employer Plan
I want all or part of my PLSD transferred to the plan named on the attached Rollover of Refund or PLSD (TMRS_ROLL) form.
MEMBER CERTIFICATIONI certify and understand that:
I have received the printed explanation, Special Tax Notice Regarding Plan Payments, prior to signing this certification and waive the
requirement of 30 days notice.
Federal income tax law requires TMRS to withhold 20% income tax from the taxable portion of my PLSD subject to federal income taxation
unless I elect to have the taxable portion transferred directly to an IRA or other employer plan that accepts rollovers.
X
Member’s Signature Date Signed (MM/DD/YYYY)
Please read the instructions provided with this form.
TMRS • P.O. Box 149153 • Austin, Texas 78714-9153 • 800.924.8677 • 512.476.7577 • FAX 512.476.5576 • www..com *TMRSPLSD*
TMRS - PLSD • Revised 4-2010 TMRS-PLSD • Page 1
®
PURPOSE
The selection of Partial Lump Sum Distribution (TMRS-PLSD) form allows you to receive a one-time, partial lump sum payment in
addition to your monthly retirement benefit. If you are taking a Partial Lump Sum Distribution, you must complete and return this
form to TMRS along with your retirement application. Election of the Partial Lump Sum Distribution (PLSD) will reduce your monthly
annuity payment.
INFORMATION ABOUT HOW THE PLSD IS CALCULATED
In the “Partial Lump Sum Election” section, you should check either 12, 24, or 36. The amount of the Partial Lump Sum Distribution is
calculated by multiplying the amount of the Retiree Life Only option times 12, 24, or 36. This calculation is part of the estimate that
should be provided to you prior to making this election.
WHEN TO EXPECT YOUR PARTIAL LUMP SUM DISTRIBUTION
Your Partial Lump Sum Distribution payment will be deposited electronically along with your first monthly payment to the financial
institution and the account indicated on your TMRS Direct Deposit Authorization (TMRS-80E) form. Any portion of the payment that
is rolled over will be sent directly to the financial institution that you indicate.
If you are rolling over any portion of your PLSD to an eligible plan, that portion of your PLSD will be mailed directly to the financial
institution you named. Please review the rollover information included in the attached Special Tax Notice Regarding Plan Payments
before you complete the Selection of Partial Lump Sum Distribution (TMRS-PLSD) form and Rollover of Refund or PLSD (TMRS-ROLL)
form.
The portion of the payment that is not rolled over to an IRA or eligible employer plan will be mailed to your personal address listed
on this form.
TMRS-PLSD • Page 2
Rollover of Refund or PLSD
To be submitted in addition to any Application for a Lump Sum Payment
PAYEE INFORMATION
Please type or use only black ink and do not highlight. Any corrections must be initialed.
Payee Name (first, middle, last) Social Security Number
Home Mailing Address Daytime Phone Number
City State Zip
I have completed an application for payment and have selected a Direct Rollover to an IRA or Employer Plan for the lump sum distribution payment
option. I wish to have the funds transferred to the plan named below and represent to TMRS that it is an eligible plan for the purpose of this trans-
fer. In addition, I do understand that any portion of the lump sum payment that is not rolled over and is paid directly to me will be subject to federal
income taxation. In addition, rollovers to Roth IRAs will result in income subject to federal income taxation. Note to TMRS members: The IRS may
require you to pay a 10% tax penalty, in addition to the regular federal income tax, on a lump sum distribution sent directly to you. You may wish to
consult with a tax advisor or the IRS to determine your potential liability.
ROLLOVER AMOUNT (Choose only one):
If you want to rollover any part of the nontaxable portion of this distribution, please contact TMRS for further instructions.
the taxable portion only OR $_____________ (specific amount or %)
ACCOUNT DESCRIPTION
For TMRS Members, Retirees, Former Spouses and Surviving Spouses:
Employer Plan
Traditional IRA
Roth IRA: TMRS will not withhold federal income taxes without further instructions. Please contact TMRS for assistance.
For Non-spouse Beneficiary Payees Only:
Inherited IRA
ROLLOVER INFORMATION
Name of Rollover Institution
Address of Rollover Institution City State Zip
Account Number (if applicable) Phone Number of Rollover Institution
X
TMRS Account Holder’s Signature Date Signed (MM/DD/YYYY)
TMRS WILL NOT ACCEPT
Attachments (including rollover forms from other retirement plans)
Alterations without initials
An incomplete form or any attempt to change its provisions
Requests for rollovers to SIMPLE IRAs, Coverdell Education Savings Accounts, or nongovernmental 457(b) plans
Requests for rollovers to the following retirement systems: Texas County and District Retirement System, Employees Retirement System of Texas,
Judicial Retirement System of Texas, Teacher Retirement System of Texas, or the City of Austin Employees Retirement Plan, unless the rollover has
been approved by the respective system to purchase service credit
TMRS • P.O. Box 149153 • Austin, Texas 78714-9153 • 800.924.8677 • 512.476.7577 • FAX 512.476.5576 • www..com TMRS-ROLL
TMRS - ROLL • Revised 6-2010
®
Revised 4-2010 • TMRS-0005 and TMRS-PLSD
You are receiving this notice because all or a portion of a payment you are receiving from the Texas Municipal Retirement System (TMRS) is
eligible to be rolled over to an IRA or an employer plan. This notice contains important information you will need before you decide how to receive
your TMRS benefits.
Rules that apply to most payments from TMRS are described in the “General Information About Rollovers” section. Special rules that only apply
in certain circumstances are described in the “Special Rules and Options” section.
If you have additional questions after reading this notice, contact the Texas Municipal Retirement System at (800) 924-8677, by mail at
P.O. Box 149153, Austin, Texas 78714-9153, or through e-mail at phonecenter@tmrs.com.
How can a rollover aect my taxes?
You will be taxed on a payment from TMRS if you do not roll it over. If
you are under age 59½ and do not roll your payment over, you will also
have to pay a 10% additional income tax on early distributions (unless
an exception applies).
If you do a rollover to a traditional IRA or an eligible employer plan,
you will not have to pay tax until you receive payments later from the
IRA or plan, and the 10% additional income tax will not apply if those
payments are made after you are age 59½ (or if an exception applies).
If you do a rollover to a Roth IRA, you will be taxed on the amount rolled
over (reduced by any after-tax amount). However, if you are under age
59 ½ at the time of the rollover, the 10% additional income tax will not
apply. See the section below titled “If you roll over your payment to a
Roth IRA” for more details.
Where may I roll over the payment?
You may roll over the payment to either an IRA (an individual retire-
ment account or individual retirement annuity) or an employer plan (a
tax-qualified plan, section 403(b) plan, or governmental section 457(b)
plan) that will accept the rollover. The rules of the IRA or employer plan
that holds the rollover will determine your investment options, fees,
and rights to payment from the IRA or employer plan (for example, no
spousal consent rules apply to IRAs, and IRAs may not provide loans).
Further, the amount rolled over will become subject to the tax rules that
apply to the IRA or employer plan.
How do I do a rollover?
There are two ways to do a rollover. You can do either a direct rollover
or a 60-day rollover.
If you do a direct rollover, TMRS will make the payment directly to your
IRA or an employer plan. You should contact the IRA sponsor or the
administrator of the employer plan for information on how to do a direct
rollover.
If you do not do a direct rollover, you may still do a rollover by making a
deposit into an IRA or eligible employer plan that will accept it. You will
have 60 days after you receive the payment to make the deposit. If you
do not do a direct rollover, TMRS is required to withhold 20% of the pay-
ment for federal income taxes. This means that in order to roll over the
entire payment in a 60-day rollover, you must use other funds to make
up for the 20% withheld. If you do not roll over the entire amount of the
payment, the portion not rolled over will be taxed and will be subject
to the 10% additional income tax on early distributions if you are under
age 59½ (unless an exception applies).
SPECIAL TAX NOTICE REGARDING PLAN PAYMENTS
FROM THE TEXAS MUNICIPAL RETIREMENT SYSTEM
How much may I roll over?
If you wish to do a rollover, you may roll over all or part of the amount eli-
gible for rollover. Any payment from TMRS is eligible for rollover, except:
Certain payments spread over a period of at least 10
years or over your life or life expectancy (or the lives or
joint life expectancy of you and your beneficiary)
Required minimum distributions after age 70½
(or after death)
Corrective distributions of contributions that exceed tax
law limitations
TMRS can tell you what portion of a payment is eligible for rollover.
If I don’t do a rollover, will I have to pay the 10%
additional income tax on early distributions?
If you are under age 59½, you will have to pay the 10% additional in-
come tax on early distributions for any payment from TMRS (including
amounts withheld for income tax) that you do not roll over, unless one
of the exceptions listed below applies. This tax is in addition to the
regular income tax on the payment not rolled over.
The 10% additional income tax does not apply to the following
payments from TMRS:
Payments made after you separate from service if you
will be at least age 55 in the year of the separation
Payments that start after you separate from service if
paid at least annually in equal or close to equal amounts
over your life or life expectancy (or the lives or joint life
expectancy of you and your beneficiary)
Payments from a governmental defined benefit pension
plan made after you separate from service if you are a
public safety employee and you are at least age 50 in
the year of the separation from a TMRS employer
Payments made due to disability
Payments after your death
Corrective distributions of contributions that exceed tax
law limitations
Payments made directly to the government to satisfy
a federal tax levy
Payments made under a qualified domestic relations
order (QDRO)
Payments up to the amount of your deductible
medical expenses
GENERAL INFORMATION ABOUT ROLLOVERS
1
Revised 4-2010 • TMRS-0005 and TMRS-PLSD
If I do a rollover to an IRA, will the 10% additional
income tax apply to early distributions from the IRA?
If you receive a payment from an IRA when you are under age 59½, you
will have to pay the 10% additional income tax on early distributions
from the IRA, unless an exception applies. In general, the exceptions
to the 10% additional income tax for early distributions from an IRA are
the same as the exceptions listed above for early distributions from
a plan. However, there are a few dierences for payments from an
IRA, including:
There is no exception for payments after separation
from service that are made after age 55.
The exception for qualified domestic relations orders
(QDROs) does not apply (although a special rule applies
under which, as part of a divorce or separation
agreement, a tax-free transfer may be made directly
to an IRA of a spouse or former spouse).
The exception for payments made at least annually in
equal or close to equal amounts over a specified period
applies without regard to whether you have had a
separation from service.
There are additional exceptions for (1) payments for
qualified higher education expenses, (2) payments up
to $10,000 used in a qualified first-time home purchase,
and (3) payments after you have received unemployment
compensation for 12 consecutive weeks (or would have
been eligible to receive unemployment compensation
but for self-employed status).
You should contact the IRA administrator for questions regarding early
distributions.
Will I owe State income taxes?
This notice does not describe any State or local income tax rules
(including withholding rules). Texas does not currently have a state
income tax.
SPECIAL RULES AND OPTIONS
If your payment includes after-tax contributions
After-tax contributions included in a payment are not taxed. If a pay-
ment is only part of your benefit, an allocable portion of your after-tax
contributions is generally included in the payment.
You may roll over to an IRA a payment that includes after-tax contribu-
tions through either a direct rollover or a 60-day rollover. You must
keep track of the aggregate amount of the after-tax contributions in all
of your IRAs (in order to determine your taxable income for later pay-
ments from the IRAs). If you do a direct rollover of only a portion of the
amount paid from TMRS and a portion is paid to you, each of the pay-
ments will include an allocable portion of the after-tax contributions.
If you do a 60-day rollover to an IRA of only a portion of the payment
made to you, the after-tax contributions are treated as rolled over last.
For example, assume you are receiving a complete distribution of your
benefit that totals $12,000, of which $2,000 is after-tax contributions.
In this case, if you roll over $10,000 to an IRA in a 60-day rollover, no
amount is taxable because the $2,000 amount not rolled over is treat-
ed as being after-tax contributions.
You may roll over to an employer plan all of a payment that includes
after-tax contributions, but only through a direct rollover (and only if the
receiving plan separately accounts for after-tax contributions and is not
a governmental section 457(b) plan). You can do a 60-day rollover to
an employer plan of part of a payment that includes after-tax contribu-
tions, but only up to the amount of the payment that would be taxable
if not rolled over.
If you miss the 60-day rollover deadline
Generally, the 60-day rollover deadline cannot be extended. However,
the IRS has the limited authority to waive the deadline under certain
extraordinary circumstances, such as when external events prevented
you from completing the rollover by the 60-day rollover deadline. To
apply for a waiver, you must file a private letter ruling request with the
IRS. Private letter ruling requests require the payment of a nonrefund-
able user fee. For more information, see IRS Publication 590, Individual
Retirement Arrangements (IRAs).
If you were born on or before January 1, 1936
If you were born on or before January 1, 1936 and receive a lump sum
distribution that you do not roll over, special rules for calculating the
amount of the tax on the payment might apply to you. For more infor-
mation, see IRS Publication 575, Pension and Annuity Income.
If you roll over your payment to a Roth IRA
If you roll over the payment to a Roth IRA, a special rule applies under
which the amount of the payment rolled over (reduced by any after-
tax amounts) will be taxed. However, the 10% additional income tax
on early distributions will not apply (unless you take the amount rolled
over out of the Roth IRA within 5 years, counting from January 1 of the
year of the rollover). For payments from TMRS during 2010 that are
rolled over to a Roth IRA, the taxable amount can be spread over a
2-year period starting in 2011.
If you roll over the payment to a Roth IRA, later payments from the Roth
IRA that are qualified distributions will not be taxed (including earnings
after the rollover). A qualified distribution from a Roth IRA is a payment
made after you are age 59½ (or after your death or disability, or as a
qualified first-time homebuyer distribution of up to $10,000) and after
you have had a Roth IRA for at least 5 years. In applying this 5-year rule,
you count from January 1 of the year for which your first contribution
was made to a Roth IRA. Payments from the Roth IRA that are not quali-
fied distributions will be taxed to the extent of earnings after the roll-
over, including the 10% additional income tax on early distributions (un-
less an exception applies). You do not have to take required minimum
distributions from a Roth IRA during your lifetime. For more information,
see IRS Publication 590, Individual Retirement Arrangements (IRAs).
You cannot roll over a payment from TMRS to a designated Roth
account in an employer plan.
2
Revised 4-2010 • TMRS-0005 and TMRS-PLSD
IF YOU ARE NOT A TMRS PARTICIPANT
Payments after death of the participant. If you receive a distribution
after the participant’s death that you do not roll over, the distribution
will generally be taxed in the same manner described elsewhere in this
notice. However, the 10% additional income tax on early distributions
and the special rules for public safety ocers do not apply, and the
special rule described under the section “If you were born on or before
January 1, 1936” applies only if the participant was born on or before
January 1, 1936.
If you are a surviving spouse
If you receive a payment from TMRS as the surviving spouse of a
deceased participant, you have the same rollover options that the
participant would have had, as described elsewhere in this notice. In
addition, if you choose to do a rollover to an IRA, you may treat the
IRA as your own or as an inherited IRA.
An IRA you treat as your own is treated like any other IRA of yours, so
that payments made to you before you are age 59½ will be subject to
the 10% additional income tax on early distributions (unless an excep-
tion applies) and required minimum distributions from your IRA do not
have to start until after you are age 70½. You should contact the IRA
administrator for questions regarding early distributions.
If you treat the IRA as an inherited IRA, payments from the IRA will not
be subject to the 10% additional income tax on early distributions. How-
ever, if the participant had started taking required minimum distribu-
tions, you will have to receive required minimum distributions from the
inherited IRA. If the participant had not started taking required mini-
mum distributions from the Plan, you will not have to start receiving
required minimum distributions from the inherited IRA until the year the
participant would have been age 70½.
If you are a surviving beneficiary other than a spouse
If you receive a payment from TMRS because of the participant’s death
and you are a designated beneficiary other than a surviving spouse, the
only rollover option you have is to do a direct rollover to an inherited
IRA. Payments from the inherited IRA will not be subject to the 10%
additional income tax on early distributions. You will have to receive
required minimum distributions from the inherited IRA.
Payments under a qualified domestic relations order. If you are the
spouse or former spouse of the participant who receives a payment
from TMRS under a qualified domestic relations order (QDRO), you
generally have the same options the participant would have had (for
example, you may roll over the payment to your own IRA or an eligible
employer plan that will accept it). Payments under the QDRO will not be
subject to the 10% additional income tax on early distributions.
OTHER SPECIAL RULES
If you are an eligible retired public safety ocer and your pension
payment is used to pay for health coverage or qualified long-term
care insurance
If you retired as a public safety ocer, and your retirement was by rea-
son of disability or was after normal retirement age, you can exclude
from your taxable income plan payments paid directly as premiums
to an accident or health plan (or a qualified long-term care insurance
contract) that your employer maintains for you, your spouse, or your
dependents, up to a maximum of $3,000 annually. For this purpose, a
public safety ocer is a law enforcement ocer, firefighter, chaplain, or
member of a rescue squad or ambulance crew.
If you are a nonresident alien
If you are a nonresident alien and you do not do a direct rollover to a
U.S. IRA or U.S. employer plan, instead of withholding 20%, TMRS is
generally required to withhold 30% of the payment for federal income
taxes. If the amount withheld exceeds the amount of tax you owe (as
may happen if you do a 60-day rollover), you may request an income
tax refund by filing Form 1040NR and attaching your Form 1042-S. See
Form W-8BEN for claiming that you are entitled to a reduced rate of
withholding under an income tax treaty. For more information, see also
IRS Publication 519, U.S. Tax Guide for Aliens, and IRS Publication 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities.
You may have special rollover rights if you recently served in the U.S.
Armed Forces. For more information, see IRS Publication 3, Armed
Forces’ Tax Guide.
FOR MORE INFORMATION
You may wish to consult with TMRS, or a professional tax advisor, before taking a payment from TMRS. Also, you can find more detailed information
on the federal tax treatment of payments from employer plans in: IRS Publication 575, Pension and Annuity Income; IRS Publication 590, Individual
Retirement Arrangements (IRAs); and IRS Publication 571, Tax-Sheltered Annuity Plans (403(b) Plans). These publications are available from a local
IRS oce, on the web at www.irs.gov, or by calling 1-800-TAX-FORM.
3
Acceptable Proofs of Birth
Purpose:
Date of birth must be verified before payment of any monthly annuity can be made. Date of birth may be
established by providing an unaltered photocopy of any one of the documents listed below.
● Texas Drivers License or Texas Identification Card
● Ocial Certificate of Birth issued by the state in which the birth occurred. Consult the County Clerk for
necessary forms and instructions. No hospital issued certificates.
● Delayed Certificate of Birth issued by the state in which the birth occurred. Consult the County Clerk for
necessary forms and instructions.
● Bureau of Census Transcript from Dallas, Texas, 214.640.4470, stating the age of the individual at the time a
census was registered.
● Baptismal or Parish Record indicating the age of the individual at the time of baptism. Please complete a
Baptismal or Parish Record Adavit if this form of proof of birth is submitted (contact TMRS at 800.924.8677.
● Family Bible Record indicating the birth date of the individual. Please complete a Family Bible Record
Adavit if this form of proof of birth is submitted (contact TMRS at 800.924.8677).
● Naturalization/Immigration Certificate indicating the age of the individual.
● Armed Forces Discharge Papers (DD214 or equivalent).
● Signed letter from Social Security Administration indicating the date of birth of the individual, which has
been accepted by Social Security Administration.
● Passport.
● School Record.
● Insurance Policy (must be at least 10 years old).
● Marriage License indicating either date of birth or age at time of marriage of individual.
● Child’s Birth Certificate indicating age of parent (individual whose date of birth is being certified).
Name Certification
If the name provided on the proof of birth is dierent from the name on TMRS records, a Name Certification
(TMRS-30) must be completed by the member or beneficiary that certifies the two names are the same person.
TMRS•P.O.Box149153•Austin,Texas78714-9153•800.924.8677•512.476.7577•FAX512.476.5576•www.tmrs.com *TMRS0027*
TMRS-0027•Revised7-2009
®
Name Certification
MEMBER INFORMATION
Please type or use only black ink and do not highlight. Any corrections must be initialed.
TMRS Identification Number (not required)
Member’s Name (first, middle, last) Social Security Number
Mailing Address Daytime Phone Number
City State Zip City Name (required)
City Number
PURPOSE
The purpose of this Name Certification is to certify that even though names may dier on plan records, the
person is one and the same. Completion of this form is mandatory only if the name(s) on the proof of birth is
dierent from the name(s) on TMRS records.
I,
, hereby certify and do solemnly swear that I am
(Aant’s name as indicated on TMRS record)
, and my true and correct date of birth is .
(Aant’s name as indicated on proof of birth) (MM/DD/YYYY)
Aant’s Signature Date Signed (MM/DD/YYYY)
NOTARIZATION REQUIRED
The State of Texas
County of
Before me on this day personally appeared , known
to me to be the person who signed the above Name Certification and declared to me upon oath that the
statement therein contained are true and correct. Given under my hand and seal of oce this day
of , 20 .
(SEAL)
Notary Public, State of Texas
NOTICE TO PERSONS SIGNING THIS AFFIDAVIT
Section 851.101 of the Texas Government Code provides for punishment by fine and/or imprisonment of
(i) a person who knowingly makes a false statement in a report or application to the retirement system in an
attempt to defraud the system or (ii) a person who knowingly makes a false certificate of an ocial report to
the retirement system.
 *TMRS0030*

01010
Plano
®
Direct Deposit Authorization
NOTE: Please complete the Certication of Trust and Authorization form located
on our website for direct deposit of payments to a Trust Account.
PAYEE'S PERSONAL DATA
Please type or use only black ink and do not highlight. Mail or fax completed form to TMRS.
Name (first, middle, last) Social Security Number
Mailing Address Date of Birth (MM/DD/YYYY)
City State Zip Daytime Phone Number
E-mail Address TMRS Identification Number (not required)
FINANCIAL INSTITUTION DATA
Financial Institution Name Financial Institution Phone Number
To ensure accuracy, please tape a voided check here (no deposit slips).
Routing Number (first nine digits) Payee Account Number Individual's Name(s) on Financial Account*
Type of Account: q Checking q Savings
PAYEE'S AUTHORIZATION
I authorize the Texas Municipal Retirement System (TMRS) to deposit my TMRS retirement benefit electronically to the financial institution and the account indicated above.
I authorize TMRS and the Financial Institution to correct any credit entries made in error. I hereby authorize the financial institution named above to disclose to TMRS at any
time my address and contact information, and to disclose the names and address of all joint owners, signatories, beneficiaries or other persons associated with the above
referenced account if I pass away. A photocopy of this signed form shall be sufficient authorization for such disclosure. Making false or misleading statements on any form
submitted to TMRS is a violation of State law and has criminal and potential civil liability.
Payee's Signature
Date (MM/DD/YYYY)
TMRS • P.O. Box 149153 Austin, Texas 78714-9153 • 800.924.8677 • 512.476.7577 • FAX 512.476.5576 • www.tmrs.com
*TMRS080E*
TMRS - 080E • Revised 9-2015
Important
Information
About Direct Deposit
■ Account Changes
If you change your account
or account number, you
must file another direct
deposit authorization.
■
Fund Availability
Generally, your money
will be deposited to your
account and available by
the last business day of
the month.
* Note:
If you are not an account holder on this account, we cannot process
your request for direct deposit.
Please check one.
JOHN DOE
123 ANYPLACE TRL.
SOMEWHERE, TX
⑆113000029⑆ 004499123456⑈ 1234
For
Bank of Somewhere
Date
Pay to the
order of
$
1234
Dollars
SAMPLE
Application for Insurance Premium Deductions
For Retired Public Safety Ocers
(to be completed by retiree and city ocial of last employing city)
RETIREE INFORMATION •
Please&type&or&use&only&black&ink&and&do&not&highlight.&Any&corrections&must&be&initialed.
Retiree’s Name (first, middle, last) Social Security Number
Mailing Address Daytime Phone Number
City State Zip
Last Employing City TMRS Identification Number (not required)
PAYMENT INFORMATION
Pay to the order of: Account/Policy Number
Remittance Address Insurance Contact Phone Number
City State Zip
$
Monthly deduction elected (in dollars) Date Eective (MM/YYYY ) Name of Insurance Company (if dierent from Payee above)
Please&note&that&you&may&deduct&any&amount&that&does&not&exceed&your&net&monthly&annuity.&However,&the&amount&that&may&be&excluded&from&your&taxable&income&in
RQH\HDUFDQQRWH[FHHG<RXPD\ZLVKWRFRQVXOWZLWK\RXUWD[DGYLVRURUWKH,QWHUQDO5HYHQXH6HUYLFHWRGHWHUPLQH\RXUHOLJLELOLW\IRUWKLVEHQH¿W
RETIREE CERTIFICATION
I certify that I was an eligible Public Safety Ocer (see definition in instructions provided with this form) when I terminated employment from
my last employing city. I elect to have the amount indicated above deducted from my monthly TMRS benefit to pay for my qualified insurance
premium, to remit the deduction as directed above, and certify that I have not elected to pay for my qualified insurance premium from any other
retirement plan. I certify that TMRS is not responsible for lapsed insurance coverage or any other coverage or benefit issues that arise because of
payment of premiums through this deduction arrangement. I waive any claims of any kind against TMRS arising from this payment arrangement,
including additional tax liability, and hereby indemnify and release TMRS from any liability arising from the administration of the payment of my
qualified insurance premium. I authorize TMRS to discuss this insurance with my insurance carrier or former employer.
Retiree's Signature Date Signed (MM/DD/YYYY)
7056ZLOOLVVXHRQHPRQWKO\SD\PHQWIRUWKHTXDOL¿HGLQVXUDQFHSUHPLXPRQWKHODVWEXVLQHVVGD\RIHDFKPRQWKXQWLO7056LVQRWL¿HGRWKHUZLVH7KHFKDQJHVLQ
WKHPRQWKO\EHQH¿WSD\PHQWZLOOWDNHHIIHFWWKHPRQWKDIWHU7056UHFHLYHVWKLVIRUP
CITY CERTIFICATIONt&(to&be&completed&by&last&employing&city)
I hereby certify that the above named retiree was an eligible Public Safety Ocer (see definition in instructions provided with this form) at the
time of separation and was employed by the city in one of the following capacities:
TPolice Ocer, Firefighter, Emergency Medical Services Employee, Corrections Ocer, Probation Ocer, Parole Ocer, Judicial Ocer
TOther:
Signature of City Ocial Date Signed (MM/DD/YYYY)
Printed Name and Title City Name
Please read the instructions provided with this form.
5.34t10#PYt"VTUJO5FYBTttt'"9tXXXTMRSDPN *TMRSHLPS*
5.34)-14t3FWJTFE
City of Plano
01010
P.O. Box 860279
972-941-5213
Plano
TX
75074
Human Resources Analyst
Plano
®
PURPOSE
The Pension Protection Act (PPA) of 2006 allows retired or permanently disabled public safety ocers (defined below) to elect an
amount to be deducted from their TMRS benefit payment to pay for health or long-term care insurance premiums in order to reduce
their taxable income. The health insurance or long-term care insurance coverage can include the retiree, spouse, and dependents.
You may deduct any amount that does not exceed your net monthly annuity. However, the amount that may be excluded from your
taxable income on your individual tax return cannot exceed $3,000 in one year. You may wish to consult with your tax advisor or the
IRS to determine your eligibility for this benefit.
DEFINITION OF A PUBLIC SAFETY OFFICER
Under Section 845 (Healthcare Enhancement for Local Public Safety, or HELPS Provision) of the Pension Protection Act, the
term “eligible public safety ocer” means an individual who, by reason of disability or attainment of normal retirement age, is
separated from service as a public safety ocer. The PPA uses the definition in Section 1204(8)(A) of the Omnibus Crime Control
and Safe Streets Act of 1968 (42 U.S.C. 3796b(9)(A)). That definition includes the following individuals serving a public agency in
an ocial capacity:
Q
An individual involved in crime and juvenile delinquency control or reduction, or enforcement of the criminal laws
(including juvenile delinquency), including, but not limited to police, corrections, probation, parole, and judicial ocers
Q
Professional firefighters
Q
Ocially recognized or designated:
Q
Public employee members of a rescue squad or ambulance crew
Q
Chaplains of fire departments and police departments
DEDUCTIONS WILL BE PAID DIRECTLY TO THE INSURER OR FORMER EMPLOYER
TMRS must pay the insurance premium directly to the insurance provider or your former employer in order for you to be eligible
to exclude up to $3,000 in any tax year from your taxable income. TMRS will not deduct more than one monthly premium from
a benefit payment, and deductions will be limited to the net monthly benefit. TMRS will issue insurance payments once a month
on the last business day of each month until notified in writing by the retiree. The changes in the monthly benefit payment will
take eect the month after TMRS receives this form.
COMPLETION OF PAYMENT INFORMATION
In this section you designate the entity to receive your insurance premium. If your current arrangement requires you to pay the
insurance carrier, third party administrator, or the city, place their name on the “Pay to the order of” line. TMRS is not responsible
for any lapsed insurance coverage. Therefore you must make arrangements for premium payments that become due before this
change takes eect. Changes take eect one month after TMRS receives this form.
WHAT IF THE INSURANCE CARRIER OR PREMIUM AMOUNT CHANGES?
You must complete a new TMRS-HLPS form to change the insurance carrier or change the amount being deducted for insurance
premiums. You must pay your insurance provider directly for the dierence (if any) between the premium due and the amount
deducted from your pension. TMRS is not responsible for lapsed insurance coverage or any other coverage or benefit issues that
arise because of payment of premiums through this deduction arrangement.
IS THIS DEDUCTION AVAILABLE TO PAYEES OTHER THAN THE RETIREE?
No, this deduction is available only to retired members. No other payee is eligible to make this election.
Employee Name _______________________________
Employee ID#_______________________
457 Deferred Compensation Plan
Final Payout Information Form
2020 Year to Date Contributions: as of _______________________ $___________________________
Remaining Contribution Amount $___________________________
I do _____/I do not_____
elect to have my final vacation payout contributed to my 457 deferred
compensation plan account with ICMA-RC.
I do _____/I do not_____ elect to have my final sick payout contributed to my 457 deferred
compensation plan account with ICMA-RC.
I do _____/I do not_____ elect to have my final paycheck contributed to my 457 deferred compensation
plan account with ICMA-RC.
_____I do not participate in the 457 Deferred Compensation Plan.
For HR:
____ Maximum Contribution
____ Age 50 Catch-Up
____ Pre-Retirement Catch-Up
_________________________________________________ ___________________________________
Employee’s Signature Date
Name:
Employee ID#:
Retirement Date:
MAILING ADDRESS:
City: State: Zip:
RSP INFORMATION:
RSP TYPE OF BENEFIT*
Life Only:
Joint & Survivor 100%:
Joint & Survivor 50%:
5 Year Certain & Life:
10 Year Certain & Life:
Total & Permanent Disability:
Deferred Vested
Signature:
Date:
*Estimate must be run by the Human Resources Department prior to completion of form
RSP ELECTION FORM
Revised 1-2020
Street:
Start Date:
$
$
$
$
$
$
Revised 1-2020
Employee Name (please print)
Employee ID #
RETIREMENT SECURITY PLAN (RSP)
BENEFICIARY DESIGNATION
I elect a single beneficiary as listed below:
Name Relationship
Street Address City, State, Zip
I elect multiple beneficiaries as listed below:
Name Relationship
Street Address City, State, Zip
Name Relationship
Street Address City, State, Zip
Name Relationship
Street Address City, State, Zip
Employee Signature Date
Note: For Joint & Survivor and Certain & Life Options Only
Authorization Agreement for
Automatic Deposits (ACH) Credits
I hereby authorize Frost Bank, to initiate credit entries and to initiate, if necessary, debit entries and
adjustments for any entries in error to my __ Checking __ Savings account (select one) indicated
below and the Bank named below to credit and/or debit the same account. This
completed document may be faxed directly to Frost Bank at 1-210-220-5577 or sent to the City of
Plano to be forwarded to Frost Bank.
To Be Completed by Retirement Plan Participant
Name of Company for which retirement is received: City of Plano Retirement Security Plan
Participant Name: ___________________________________ Employee ID#:_________________
Social Security Number: XXX-XX- (last 4 digits only)
Address:
City: State: Zip Code:
Bank Name: Telephone #:
Transit/ABA #: Account #:
This authorization is to remain in full force and effect until Frost Bank has received written notification
from me of its termination in such time and in such manner as to afford Frost Bank a reasonable
opportunity to act on it.
Participant Signature: Date:
You may also attach a voided check below.
Revised 1-2019
City of Plano Retiree Health Benefits Change Form 2020
Retiree Name: Employee #
Change FROM: Change TO:
Active Retired
Coverage Waived Coverage Activated
Non Medicare Medicare A & B
Retired Coverage Waived
Coverage Terminated
COMPLETED CHANGE FORM MUST BE RECEIVED IN THE
HUMAN RESOURCES DEPARTMENT WITHIN 31 DAYS OF THE
QUALIFYING EVENT
QUALIFYING EVENT:
Birth/Adoption Dependent Age Limit Gain/Loss of Coverage
Death Marriage Divorce
Add Dependents Terminate Depende
nts
Last Name, First Effectiv
e Date SS# DOB
All retirees are required to provide dependent eligibility documentation as well as
social security numbers for each dependent for whom enrollment is requested.
Documentation shall consist of at least one of the following documents:
• Spouse – Copy of marriage license or common law certificate filed with the state
• Biological Child – Copy of birth certificate
• Stepchild – Copy of birth certificate that shows retiree’s current spouse as
biological parent
• Adopted Child – Copy of adoption documents
• Grandchild, Foster, Custodial or Similar Child – Copy of appropriate legal
documents showing a parent/child relationship exits
1
City of Plano Retiree Health Benefits Change Form 2020
COVERAGE
MEDICAL: LEVEL OF COVERAGE:
United Healthcare Core Retiree Only
Medicare Plan Retiree + Spouse
Waive Retiree + Children
Retiree + Family
DENTAL:
LEVEL OF COVERAGE:
United Healthcare Dental Retiree Only
Waive Retiree + Spouse
Retiree + Children
Retiree + Family
VISION:
LEVEL OF COVERAGE:
United Healthcare Vision Retiree Only
Waive Retiree + Spouse
Retiree + Children
Retiree + Family
HOSPITAL GAP:
LEVEL OF COVERAGE:
Age 500 1000 1500 Retiree Only
18-54 Retiree + Spouse
55-59 Retiree + Children
60-99 Retiree + Family
Waive
An updated Hospital Gap Enrollment F
orm is required when adding or dropping coverage.
This form is considered a legal document. I acknowledge that I must terminate my health
insurance coverage by contac
ting the City
of
P
lano
Human
Resources
depar
tment
s
hould
I
obtain
fulltime employment
with
a
n employer
that
offers health insurance.
Retiree Signature:
Date:
2
Revised 1-2020
2020 Retiree Non-Medicare
Monthly Premium Cost Worksheet
Medical Plan
Core Plan
Dental
Vision
Hospital GAP
Retiree Only
$ 538.00
$ 45.00
$ 8.54
Under 55
500
1000
1500
Retiree & Spouse
$1,392.00
$ 88.00
$13.66
Retiree Only
$14
$17
$20
Retiree & Children
$ 994.00
$108.00
$13.97
Retiree & Spouse
$26
$31
$37
Retiree & Family
$ 2,006.00
$164.00
$22.48
Retiree & Children
$25
$28
$32
Spouse Only
$ 854.00
$ 45.00
$ 8.54
Retiree & Family
$37
$42
$49
55-59
Retiree Only
$20
$24
$30
Retiree & Spouse
$37
$43
$54
Retiree & Children
$31
$35
$42
Retiree & Family
$48
$54
$66
60 +
Retiree Only
$31
$36
$46
Retiree & Spouse
$56
$65
$83
If Connect4Health Incentive Requirements not met, please add
Retiree & Children $42 $47 $58
$50 to monthly premium. Retiree & Family $67 $76 $95
CALCULATE YOUR PREMIUM
X $11* =
Years of City Service Service Credit
- + =
Selection Retiree Medical Service Credit Selection Retiree Net Rate
and Dental Rate (Retiree Vision and/or GAP Rate)
+
=
Retiree Net Rate
Dependent Rate
TOTAL MONTHLY PREMIUM
*NOTE: SERVICE CREDITS APPLY TO RETIREE MEDICAL AND DENTAL ONLY Revised 1/2020
Name: Effective Date:
Employee ID#:
Memorandum
Name:
All eligible retirees of the City of Plano have life insurance equal to one X annual salary
with a maximum $20,000 continued life insurance coverage at no cost to the retiree.
Please keep this paper in a safe location and make your beneficiary aware of this
benefit. To file a claim for the life insurance, upon the death of the retiree, the
beneficiary will need to contact the City of Plano Human Resources Department at
972-941-7115 to determine what paperwork is needed.
City of Plano Representative
Date
By signing below, I am acknowledging that I am aware of this benefit and have received
a copy of this form.
Retiree
Date
Employee ID#:
Revised 1-2020
Effective Retirement Date:
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3
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
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
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 
Retiree Information Verification
To ensure our records are up to date, please complete this form.
Mail to:
City of Plano Human Resources
Fax to:
(972) 941-7239
P.O. Box 860358
Plano, TX 75086-0358
State: Zip:
Please Print
Name:
Street Address:
City:
Home Phone:
Cell Phone:
*E-mail:
Emergency Contact Name:
Emergency Contact Phone:
*Mandatory
Revised 1-2020
Employee ID:____________
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• Retiree Health Insurance
• Retiree Life Insurance
• Other Post-Employment Benefits (OPEB)
Health
Dental
Life
Revised April 2018
2
RETIREE HEALTH INSURANCE
Eligibility to Continue Coverage Requirements
A retiring employee must qualify for early, normal, late or disability retirement as defined
by Texas Municipal Retirement System (TMRS) AND have at least five (5) years of
continuous full time City of Plano service.
Retirees and/or eligible dependents who qualify for Medicare coverage are no longer
eligible to participate in the City of Plano health, vision or dental plans.
Enrollment
A retiring employee has 31 days from their effective retirement date to:
Make a decision regarding continuation of coverage
Complete and submit applicable form(s)
Make premium payments
Continuation of coverage includes all coverage (medical, dental, & vision) an
employee is enrolled in at time of retirement. Changes to coverage may only
occur during the open enrollment period.
A retiree with coverage elsewhere may elect to continue partial coverage (i.e. only
dental, or vision) if the plan they are enrolling in does not offer a particular coverage.
Dependent Coverage
Eligible dependent(s) not on the health plan at the time the employee retirees can only
be added:
During annual open enrollment; or
If there is a qualifying event as defined by the Internal Revenue Service.
Examples of a qualifying event are: marriage, birth, divorce, loss of job, etc.
A certificate of creditable coverage is required.
Proof of dependent eligibility must be provided.
If retiree turns 65, dependent can stay on all plan until they reach 65 years of age.
3
Primary and Secondary Coverage
Health insurance coverage from other sources will be primary with City of Plano coverage
being secondary payer responsibility.
Service Credits
Before January 4, 2010, if rehired your service credits will be calculated on
original date of hire. Look at job data under benefits service date. After that date,
use RSP date to calculate service credits.
Retiring employees who meet the retirement eligibility requirements and have at
least ten (10) years of continuous full time employment are eligible for service credits
equal to $11 for each full year of service (i.e.12 years X $11 = $132) with
a maximum of thirty (30) years ($330).
Service credits apply to the cost of premiums for the retiree only. Any excess
credits cannot be used for dependent coverage.
Non Medicare eligible retirees: service credits apply
only to medical and dental premiums.
Medicare eligible retirees: service credits apply only to
Medicare medical and prescription drug premiums offered
through the City of Plano.
Retirees approved for Retirement Security Plan (RSP) Total and Permanent Disability
Retirement will receive a 50% reduction in the cost of the retiree’s applicable premium.
Any service credit amount is applied after the 50% reduction.
Service Credit Chart
10 years = $110 17 years = $187 24 years = $264
11 years = $121 18 years = $198 25 years = $275
12 years = $132 19 years = $209 26 years = $286
13 years = $143 20 years = $220 27 years = $297
14 years = $154 21 years = $231 28 years = $308
15 years = $165 22 years = $242 29 years = $319
16 years = $176 23 years = $253 30 years = $330
4
Premium Payments
Retiree is responsible for full premium minus service credits.
Payments are due the first of each month.
Retirees (non-Medicare) who have been approved for Total and Permanent disability
through RSP are eligible for a 50% reduction in their medical and dental premium(s) in
addition to any applicable service credits.
Retirees (Medicare) who have been approved for Total and Permanent disability
through RSP are eligible for a 50% reduction in their medical and prescription drug
premiums in addition to any applicable service credits.
Premiums may be set up to be directly deducted from the retiree’s checking account by
completing the necessary form and submitting it to the City of Plano accounting
department.
Public Safety retirees (Police and Fire) have the option of deducting directly from their
monthly TMRS payments to pay for their medical coverage. Public Safety retirees electing
to exercise this payment option need to complete the TMRS HLPS form available through
the TMRS website at www.tmrs.org.
If direct payment is selected, Public Safety retirees must keep deduction amounts
accurate based on changes in premiums. Open enrollment changes resulting in a
decrease or increase in premiums REQUIRE each retiree to update and submit a new
HLPS form to TMRS on an annual basis, if applicable.
o Failure to update the HLPS form to reflect the correct amount to be deducted by
February 28 for March 1
st
coverage as a result of a DECREASE in insurance
premiums will result in an administrative fee of $20.00 for processing a refund
check.
o Failure to update the HLPS form by February 28 for March 1
st
coverage as a result
of an INCREASE in insurance premiums will result in monthly late fees and
penalties as provided below.
5
Late Fees and Penalties:
Payments received after the 5th of each month will result in a late
penalty as follows:
1st late payment in a calendar year will result in a $25 fee.
The monthly premium and $25 late fee must be paid by the 15th of the month for
which the premium is owed. Failure to meet this deadline will result in loss of
insurance coverage. Once coverage is lost, it cannot be reinstated.
2nd late payment in a calendar year will result in a $50 fee. The monthly premium
and $50 late fee must be paid by the 15th of the month for which the premium is
owed. Failure to meet this deadline will result in loss of insurance coverage. Once
coverage is lost, it cannot be reinstated.
3rd late payment in a calendar year will result in the loss of 50% of the retiree’s
service credits. Once service credits are lost, they will not be reinstated. Failure to
submit the late payment by the 15th of the month for which it is due will result in loss
of insurance coverage. Once coverage is lost, it cannot be reinstated.
4th late payment in a calendar year will result in the loss of ALL service credits.
Once service credits are lost, they will not be reinstated. Failure to submit the late
payment by the 15th of the month for which it is due will result in loss of insurance
coverage. Once coverage is lost, it cannot be reinstated.
5th late payment in a calendar year will result in the loss of retiree health insurance.
Once coverage is lost it cannot be reinstated. A total and permanent disability retiree
and/or dependent of a Medicare eligible retiree, having no service credits, will lose
health insurance coverage effective the 1st of the month for which payment was due
when they have more than 2 late payments in a calendar year. Once coverage is
cancelled, it cannot be reinstated.
Nonpayment of any portion of dependent’s premium will result in loss of coverage for both the retiree
and their dependent(s). Once coverage is lost for non-payment, it cannot be reinstated.
6
Annual Open Enrollment
Each year, typically in the September/October timeframe, open enrollment
information will be provided electronically via e-mail to non-Medicare eligible retirees
and also posted on the City of Plano retirement center site.
Plan changes for non-Medicare retirees can only occur during open enrollment
for coverage effective the following January 1st.
Retiree Life Insurance
Employees who retire on or after October 1, 1994, under the early normal, late or disability
provisions, with at least ten (10) years of continuous full-time employment with the City of Plano
are eligible for:
Life insurance equal to 1 times annual salary, maximum of $20,000, at no cost to the
retiree;
Conversion option (information provided at retiree out-processing).
Retirees who qualify for Total and Permanent Disability Retirement under the
Retirement Security Plan (RSP) may be eligible for additional life insurance under
the “waiver of premium” provision.
(over)
Government Pension Oset
A law that aects spouses and widows
or widowers
If you receive a retirement or disability pension
from a federal, state, or local government
based on your own work for which you didn’t
pay Social Security taxes, we may reduce your
Social Security spouses or widows or widowers
benets. This fact sheet provides answers to
questions you may have about the reduction.
How much will my Social Security
benets be reduced?
We’ll reduce your Social Security benets by
two-thirds of your government pension. In other
words, if you get a monthly civil service pension
of $600, two-thirds of that, or $400, must be
deducted from your Social Security benets. For
example, if you’re eligible for a $500 spouses,
widows, or widowers benet from Social
Security, you’ll get $100 a month from Social
Security ($500 – $400 = $100). If two-thirds of
your government pension is more than your
Social Security benet, your benet could be
reduced to zero.
If you take your government pension annuity in
a lump sum, Social Security will calculate the
reduction as if you chose to get monthly benet
payments from your government work.
Why will my Social Security benets
be reduced?
Benets we pay to spouses, widows, and
widowers are “dependent” benets. Set up in
the 1930s, these benets were to compensate
spouses who stayed home to raise a family
and were nancially dependent on the working
spouse. It’s now common for both spouses to
work, each earning their own Social Security
retirement benet. The law requires a person’s
spouse, widow, or widower benet to be offset by
the dollar amount of their own retirement benet.
For example, if a woman worked and earned
her own $800 monthly Social Security benet,
but was also due a $500 spouse’s benet on
her husband’s record, we couldn’t pay that
spouse’s benet because her own benet
offsets it. Before enactment of the Government
Pension Offset law, if that same woman was
a government employee who didn’t pay into
Social Security and earned an $800 government
pension, there was no offset. We had to pay her
a full spouse’s benet and her full government
pension.
If this person’s government work had been
subject to Social Security taxes, we would
reduce any spouse, widow, or widower
benet because of their own Social Security
retirement benet. The Government Pension
Offset ensures that we calculate the benets of
government employees who don’t pay Social
Security taxes the same as workers in the
private sector who pay Social Security taxes.
When won’t my Social Security
benets be reduced?
Generally, we won’t reduce your Social Security
benets as a spouse, widow, or widower if you:
• Receive a government pension that’s not
based on your earnings; or
• Are a federal (including Civil Service Offset),
state, or local government employee and
your government pension is from a job for
which you paid Social Security taxes; and:
—Your last day of employment (that
your pension is based on) is before
July 1, 2004; or
—You led for and were entitled to spouses,
widows, or widowers benets before
April 1, 2004 (you may work your last day
in Social Security covered employment at
any time); or
—You paid Social Security taxes on your
earnings during the last 60 months of
government service. (Under certain
Government Pension Offset
SocialSecurity.gov
conditions, we require fewer than 60
months for people whose last day of
employment falls after June 30, 2004, and
before March 2, 2009.)
There are other situations for which we won’t
reduce your Social Security benets as a
spouse, widow, or widower; for example, if you:
• Are a federal employee who switched from
the Civil Service Retirement System (CSRS)
to the Federal Employees’ Retirement System
(FERS) after December 31, 1987; and:
—Your last day of service (that your pension
is based on) is before July 1, 2004;
—You paid Social Security taxes on your
earnings for 60 months or more during
the period beginning January 1988 and
ending with the rst month of entitlement to
benets; or
—You led for and were entitled to spouses,
widows, or widowers benets before
April 1, 2004 (you may work your last day
in Social Security covered employment at
any time).
• Received, or were eligible to receive, a
government pension before December 1982
and meet all the requirements for Social
Security spouse’s benets in effect in
January 1977; or
• Received, or were eligible to receive, a
federal, state, or local government pension
before July 1, 1983, and were receiving
one-half support from your spouse.
Note: A Civil Service Offset employee
is a federal employee, rehired after
December 31, 1983, following a break in
service of more than 365 days, with ve
years of prior CSRS coverage.
What about Medicare?
Even if you don’t get benet payments from your
spouse’s work, you can still get Medicare at age
65 on your spouse’s record if you aren’t eligible
for it on your own record.
Can I still get Social Security benets
from my own work?
The offset applies only to Social Security
benets as a spouse, or widow, or widower.
However, we may reduce your own benets
because of another provision. For more
information, go online to read Windfall
Elimination Provision (Publication
No. 05-10045).
Contacting Social Security
The most convenient way to contact us anytime,
anywhere is to visit www.socialsecurity.gov.
There, you can: apply for benets; open a
my Social Security account, which you can
use to review your Social Security Statement,
verify your earnings, print a benet verication
letter, change your direct deposit information,
request a replacement Medicare card, and get a
replacement SSA-1099/1042S; obtain valuable
information; nd publications; get answers to
frequently asked questions; and much more.
If you don’t have access to the internet, we
offer many automated services by telephone,
24 hours a day, 7 days a week. Call us toll-free
at 1-800-772-1213 or at our TTY number,
1-800-325-0778, if you’re deaf or hard of hearing.
If you need to speak to a person, we can answer
your calls from 7 a.m. to 7 p.m., Monday through
Friday. We ask for your patience during busy
periods since you may experience higher than
usual rate of busy signals and longer hold times
to speak to us. We look forward to serving you.
Social Security Administration
Publication No. 05-10007 | ICN 451453 | Unit of Issue — HD (one hundred)
May 2019 (Recycle prior editions)
Government Pension Offset
Produced and published at U.S. taxpayer expense
(over)
SocialSecurity.gov
Windfall Elimination Provision
Your Social Security retirement or disability
benets can be reduced
The Windfall Elimination Provision can affect how we
calculate your retirement or disability benet. If you
work for an employer who doesn’t withhold Social
Security taxes from your salary, such as a government
agency or an employer in another country, any
retirement or disability pension you get from that work
can reduce your Social Security benets.
When your benets can be aected
This provision can affect you when you earn a
retirement or disability pension from an employer who
didn’t withhold Social Security taxes and you qualify
for Social Security retirement or disability benets from
work in other jobs for which you did pay taxes.
The Windfall Elimination Provision can apply if:
• You reached 62 after 1985.
• You became disabled after 1985.
• You rst became eligible for a monthly pension
based on work where you didn’t pay Social Security
taxes after 1985. This rule applies even if you’re
still working.
This provision also affects Social Security benets for
people who performed federal service under the Civil
Service Retirement System (CSRS) after 1956. We
won’t reduce your Social Security benet amounts if
you only performed federal service under a system
such as the Federal Employees’ Retirement System
(FERS). Social Security taxes are withheld for workers
under FERS.
How it works
Social Security benets are intended to replace only
some of a worker’s pre-retirement earnings.
We base your Social Security benet on your average
monthly earnings adjusted for average wage growth.
We separate your average earnings into three amounts
and multiply the amounts using three factors to
compute your full Primary Insurance Amount (PIA).
For example, for a worker who turns 62 in 2020, the
rst $960 of average monthly earnings is multiplied
by 90 percent; earnings between $960 and $5,785
are multiplied by 32 percent; and the balance by 15
percent. The sum of the three amounts equals the
PIA, which is then decreased or increased depending
on whether the worker starts benets before or after
full retirement age (FRA). This formula produces the
monthly payment amount.
When we apply this formula, the percentage of career
average earnings paid to lower-paid workers is greater
than higher-paid workers. For example, workers age
62 in 2020, with average earnings of $3,000 per month
could receive a benet at FRA of $1,516 (approximately
50 percent) of their pre-retirement earnings increased
by applicable cost of living adjustments (COLAs). For a
worker with average earnings of $8,000 per month, the
benet starting at FRA could be $2,740 (approximately
34 percent) plus COLAs. However, if either of these
workers start benets earlier than their FRA, we’ll
reduce their monthly benet.
Why we use a dierent formula
Before 1983, people whose primary job wasn’t
covered by Social Security had their Social Security
benets calculated as if they were long-term, low-wage
workers. They had the advantage of receiving a Social
Security benet representing a higher percentage of
their earnings, plus a pension from a job for which
they didn’t pay Social Security taxes. Congress
passed the Windfall Elimination Provision to remove
that advantage.
Under the provision, we reduce the 90 percent factor
in our formula and phase it in for workers who reached
age 62 or became disabled between 1986 and 1989.
For people who reach 62 or became disabled in 1990
or later, we reduce the 90 percent factor to as little as
40 percent.
Some exceptions
The Windfall Elimination Provision doesn’t apply if:
• You’re a federal worker rst hired after
December 31, 1983.
• You’re an employee of a non-prot organization who
was rst hired after December 31, 1983.
• Your only pension is for railroad employment.
• The only work you performed for which you didn’t
pay Social Security taxes was before 1957.
• You have 30 or more years of substantial earnings
under Social Security.
Windfall Elimination Provision
2020
The Windfall Elimination Provision doesn’t apply to
survivors benets. We may reduce spouses, widows,
or widowers benets because of another law. For
more information, read Government Pension Offset
(Publication No. 05-10007).
Social Security years of substantial earnings
If you have 30 or more years of substantial earnings,
we don’t reduce the standard 90 percent factor in our
formula. See the rst table that lists substantial earnings
for each year.
The second table shows the percentage used to
reduce the 90 percent factor depending on the number
of years of substantial earnings. If you have 21 to 29
years of substantial earnings, we reduce the 90 percent
factor to between 45 and 85 percent. To see the
maximum amount we could reduce your benet, visit
www.socialsecurity.gov/planners/retire/wep-chart.html.
A guarantee
The law protects you if you get a low pension. We won’t
reduce your Social Security benet by more than half of
your pension for earnings after 1956 on which you didn’t
pay Social Security taxes.
Contacting Social Security
The most convenient way to contact us from anywhere,
on any device, is to visit www.socialsecurity.gov.
There are several things you can do online: apply for
benets; get useful information; nd publications; and
get answers to frequently asked questions.
When you open a my Social Security account, you have
more capabilities. You can review your Social Security
Statement, verify your earnings, and print a benet
verication letter. You can also change your direct
deposit information, request a replacement Med-icare
card, request a replacement Social Security card (if you
have no changes and your state participates), and get a
replacement SSA-1099/1042S.
If you don’t have access to the internet, we offer many
automated services by telephone, 24 hours a day, 7
days a week. Call us toll-free at 1-800-772-1213 or at
our TTY number, 1-800-325-0778, if you’re deaf or hard
of hearing.
A member of our staff can answer your call from 7 a.m.
to 7 p.m., Monday through Friday, if you need to speak
to a person. We ask for your patience during busy
periods since you may experience a high rate of busy
signals and longer hold times to speak to us. We look
forward to serving you.
Social Security Administration
Publication No. 05-10045
January 2020 (Recycle prior editions)
Windfall Elimination Provision
Produced and published at U.S. taxpayer expense
Year Substantial earnings
2013 $21,075
2014 $21,750
2015-2016 $22,050
2017 $23,625
2018 $23,850
2019 $24,675
2020 $25,575
Year Substantial earnings
1937–1954 $900
1955–1958 $1,050
1959–1965 $1,200
1966–1967 $1,650
1968–1971 $1,950
1972 $2,250
1973 $2,700
1974 $3,300
1975 $3,525
1976 $3,825
1977 $4,125
1978 $4,425
1979 $4,725
1980 $5,100
1981 $5,550
1982 $6,075
1983 $6,675
1984 $7,050
1985 $7,425
1986 $7,875
1987 $8,175
1988 $8,400
Year Substantial earnings
1989 $8,925
1990 $9,525
1991 $9,900
1992 $10,350
1993 $10,725
1994 $11,250
1995 $11,325
1996 $11,625
1997 $12,150
1998 $12,675
1999 $13,425
2000 $14,175
2001 $14,925
2002 $15,750
2003 $16,125
2004 $16,275
2005 $16,725
2006 $17,475
2007 $18,150
2008 $18,975
2009–2011 $19,800
2012 $20,475
Years of substantial
earnings
Percentage
30 or more 90 percent
29 85 percent
28 80 percent
27 75 percent
26 70 percent
25 65 percent
24 60 percent
23 55 percent
22 50 percent
21 45 percent
20 or less 40 percent
(over)
Your Retirement Benefit: How It’s Figured
SocialSecurity.gov
Your Retirement Benet: How It’s Figured
As you make plans for your retirement, you
may ask, “How much will I get from Social
Security?” If you have a my Social Security
account, you can use our Retirement Calculator
at www.socialsecurity.gov/myaccount to
get an estimate of your personal retirement
benets, and to see the effects of different
retirement age scenarios. If you don’t have a
my Social Security account, you can create one
at www.socialsecurity.gov/myaccount or
you can use our online Retirement Estimator at
www.socialsecurity.gov/estimator.
Many people wonder how we gure their Social
Security retirement benet. We base Social
Security benets on your lifetime earnings.
We adjust or “index” your actual earnings to
account for changes in average wages since
the year the earnings were received. Then,
Social Security calculates your average indexed
monthly earnings during the 35 years in which
you earned the most. We apply a formula to
these earnings and arrive at your basic benet,
or “primary insurance amount.” This is how
much you would receive at your full retirement
age — 65 or older, depending on your
date of birth.
Even if you aren’t retirement age, you can plan
for retirement now. Workers age 18 and older
can also go online, create a personal account,
and review their Social Security Statement. Go
to www.socialsecurity.gov/myaccount to
review your Statement to ensure your earnings
record is correct. This is how your benets
are computed.
Factors that can change the amount of
your retirement benet
• You choose to get benets before your full
retirement age. You can begin to receive
Social Security benets as early as age 62,
but at a reduced rate. We reduce your basic
benet a certain percentage if you retire
before reaching full retirement age. You can
nd your full retirement age at www.ssa.gov/
planners/retire/retirechart.html.
• You’re eligible for cost-of-living benet
increases starting with the year you
become age 62. This is true even if you
don’t get benets until your full retirement
age or even age 70. We add cost-of-living
increases to your benet beginning with the
year you reach 62. Benets are adjusted
yearly to reect the increase, if any, in the
cost-of-living as measured by the Consumer
Price Index.
• You delay your retirement past your full
retirement age. We increase your Social
Security benets incrementally each month
that you delay receiving benets after your
full retirement age until you reach age 70.
• You’re a government worker with a pension.
If you also get, or are eligible for, a retirement
or disability pension from work for which
you didn’t pay Social Security taxes (usually
a government job or a job in a foreign
country), we apply a different formula to
your average indexed monthly earnings.
To nd out how the Windfall Elimination
Provision (WEP) affects your benets,
go to www.socialsecurity.gov/gpo-wep
and use the WEP online calculator. You
can also review the WEP fact sheet online
or read Windfall Elimination Provision
(Publication No. 05-10045) to nd out how
we gure your benet. Or, you can contact
us and ask for it.
You can nd a detailed explanation about how
we calculate your retirement benet in the
Annual Statistical Supplement, Appendix D
at www.socialsecurity.gov/policy/docs/
statcomps/supplement.
Social Security Administration
Publication No. 05-10070
January 2020 (Recycle prior editions)
Your Retirement Benefit: How It’s Figured
Produced and published at U.S. taxpayer expense
Contacting Social Security
The most convenient way to contact us
from anywhere, on any device, is to visit
www.socialsecurity.gov. There are several
things you can do online: apply for benets; get
useful information; nd publications; and get
answers to frequently asked questions.
When you open a my Social Security account,
you have more capabilities. You can review your
Social Security Statement, verify your earnings,
and print a benet verication letter. You can
also change your direct deposit information,
request a replacement Medicare card, request a
replacement Social Security card (if you have no
changes and your state participates), and get a
replacement SSA-1099/1042S.
If you don’t have access to the internet, we
offer many automated services by telephone,
24 hours a day, 7 days a week. Call us
toll-free at 1-800-772-1213 or at our TTY
number, 1-800-325-0778, if you’re deaf or
hard of hearing.
A member of our staff can answer your call
from 7 a.m. to 7 p.m., Monday through Friday,
if you need to speak to a person. We ask for
your patience during busy periods since you
may experience a high rate of busy signals
and longer hold times to speak to us. We look
forward to serving you.
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