Application for Service or Disability Retirement -Maryland
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For State employees and employees of the University System of Maryland: If you are eligible to partici-
pate in the State Employees' Health Insurance Program, only selection of Option 2, 3, 5, or 6 will allow
your eligible surviving dependents to continue health program coverage after your death. You must
choose either Option 2, 3, 5, or 6 and name your spouse as beneficiary in order for the spouse to contin-
ue health insurance after your death.
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Choose a retirement date. If you choose the first of a month as your retirement date, you will receive your
monthly retirement benefit at the end of that month. If you choose a date other than the first of the month,
your first retirement benefit will be paid the end of the following month and it will be for one month's
income only. You must be separated from employment on the date that you enter as your retirement date.
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If you have voluntary money, decide how you want that money paid to you. To verify if you have any vol-
untary money, refer to your most recent Personal Statement of Benefits or call a retirement benefits spe-
cialist at 410-625-5555 or toll-free 1-800-492-5909.
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Name your beneficiary (ies). If you have selected Option 2, 3, 5, or 6, you may only name one beneficiary.
If you choose the Basic Allowance, Option 1 or Option 4, you may name multiple beneficiaries. If you are
naming multiple beneficiaries, check the box on Form 13-23 that indicates you are submitting Form 4 with
your beneficiary information. Do not enter one beneficiary on Form 13-23 and the rest on Form 4. Enter
multiple beneficiaries on Form 4.
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Choose your payment option. Be sure you understand each option before making your choice. Your esti-
mate should be helpful in choosing the option best suited to you and to those who may rely upon you for
continuing income after your death. Contact a retirement benefits specialist if you have questions regarding
the payment options. You may not change your payment option once your first payment comes due.
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Submit proof of birth of your beneficiary if you choose Option 2, 3, 5, or 6. You may submit a copy of an
unexpired driver's license, MD identification card provided by the Motor Vehicle Administration, birth cer-
tificate, passport, or military documentation, as examples.
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If you have chosen Option 2 or Option 5 and your beneficiary is your disabled child, you must have a
physician complete the Verification of Retiree’s Disabled Child for Selection of Option 2 / 5 Beneficiary
(Form 143) and attach it to this application.
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No offers of reemployment should be made or discussed by you and your current employer until after
you have retired. Maryland law requires you to wait at least 45 days from your date of retirement before being
reemployed as a retiree by your same employer. In this instance, all state agencies including the University
System of Maryland are considered the same employer. If you return to work for the same employer, you may
be subject to an earnings limitation as well as IRS rules may apply. Refer to the information on the most current
Reemployment After Retirement (Form 127) for an explanation of the reemployment rules. If you have any
questions, contact a retirement benefits specialist at 410-625-5555 or toll-free at 1-800-492-5909.
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Again, to receive credit for any unused sick leave days you have at retirement, you must retire within 30
days from when you separated from employment. Unused sick leave is sick leave that was available to an
employee as sick leave during employment and was not used before retirement. Any converted leave that
was not sick leave during employment may not be reported.
Important Points to Know when filing the Application for Service or
Disability Retirement (Form 13-23)
Continued from previous page.
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