You must have JavaScript enabled to use this form. Name * Full Name Employee ID * Last Working Day * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year *Can be an estimate PERS Retirement Date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year202320242025 This is typically the first of the month following your last day, unless you want to postpone your PERS retirement. PERS Membership Start Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 This is needed if you've ever worked for another PERS employer. Need help? PERS: 888-320-7377 or oregon.gov/PERS/ Are you or any dependents currently eligible for Medicare? * Yes No Do you want to defer your retiree medical/dental plan enrollment? - None -YesNo You can only defer the start date of your retiree medical/dental benefits if you are enrolled on a County plan with your spouse/partner, OR if you are a MCCDA, DSA, Local 88, or FOPPO member with other employer group coverage. Retiree Health Insurance QuoteYou can enroll in the same plan you have, or choose a lesser plan with the same provider. If you currently opt-out, you may choose any plan. Retiree Medical Plan * NoneKaiser MedicalKaiser MaintenanceModa PPO 400Moda Major Medical You can select multiple plans to get multiple price quotes. Medical Coverage Level * Single Two-Party Family You can select multiple coverage levels to get multiple price quotes. Retiree Dental Plan * - Select -Kaiser DentalDelta DentalWillamette DentalNone Dental Coverage Level Single Two-Party Family Personal Email Notes/Comments Leave this field blank
Retiree Benefit Information Multnomah County offers eligible retirees the same medical and dental plans available to active employees.