If you are a retiring public safety officer, either the Retired Public Safety Officers' Insurance Payment Program Deduction Form SC Employee Insurance Program (EIP) Only (Form 7700) or the Retired Public Safety Officers' Insurance Payment Program Deduction Form Not Applicable for SC Employee Insurance Program (EIP) (Form 7701) must be completed if you wish to have qualified health insurance premiums deducted from your monthly retirement annuity and remitted directly to the provider. It is your responsibility to determine whether you qualify to claim the federal tax credit for your after-tax insurance premium payment deductions.
To avoid delays in receiving benefits, please check the following items carefully beforesubmitting your application:
Form 6302Revised 11/5/2018
RETIRING MEMBER'S SERVICE APPLICATION CHECKLIST
SC Public Employee Benefit Authority
202 Arbor Lake Drive
Columbia, SC 29223
THE LANGUAGE USED IN THIS DOCUMENT DOES NOT CREATE ANY CONTRACTUAL RIGHTS OR ENTITLEMENTS AND DOES NOT CREATE A CONTRACT BETWEEN THE MEMBER AND THE SC PUBLIC EMPLOYEE BENEFIT AUTHORITY. THE SC PUBLIC EMPLOYEE BENEFIT AUTHORITY RESERVES THE RIGHT TO REVISE THE CONTENT OF THIS DOCUMENT.
Please contact the Customer Contact Center with any questions at 803.737.6800, 888.260.9430, or www.peba.sc.gov.
Withholding Certificate for Monthly Benefit Payments (Form 7202) and Direct Deposit Authorization (Form 7204) are completed and returned to the Benefit Payments Department at S.C. Public Employee Benefit Authority (PEBA), using the envelope provided. Monthly annuity payments are distributed the last business day of each month by direct deposit.
A copy of your birth certificate (or other proof of birth if a public birth certificate does not exist) is attached.
A copy of your current driver's license or special identification card issued by your state Department of Transportation or Public Safety is attached.
Retiree health insurance
Being eligible for retirement benefits does not automatically make you eligible for retiree health insurance. Prior to selecting your retirement date, you should contact your employer or health insurance provider to determine if you will be eligible for retiree health insurance. If you have state-sponsored health insurance, you should contact PEBA at 888.260.9430 for assistance.
Last day on payroll is indicated in Section IV. This should match the date that will be provided by your employer when certifying your last day paid.
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