QPSA Information page

Instructions for Plan Representative

Please print this section and provide to your participant for further action.

Information for Plan Participant

Your plan provides that a Qualified Pre-Retirement Survivor Annuity (QPSA) be paid to your spouse in the event that your death occurs before the benefit under the plan becomes payable. A portion of the value of your vested account balance at death (between 50% and 100%, according to your plan) is used to provide a monthly payment to your spouse for life. This form of benefit is a “life annuity.” This form assumes that your plan provides for a QPSA of 100% of your vested account balance at death.

You may elect a form of distribution other than a QPSA if your plan allows. However, in order for such an election to be effective, it must be in writing and must include the consent of your spouse, witnessed by a plan representative or a Notary Public. (If you are married and cannot locate your spouse, spousal consent is not required to elect a form of distribution other than a QPSA. You will, however, need to have your designation witnessed by a plan representative or a Notary Public and your plan representative may request evidence of this designation for their records.)

The plan may provide that any such election may be revoked at any time, thereby reinstating the QPSA. You may choose to decline automatic QPSA coverage, but only under certain circumstances, as described below. The period during which you may elect to decline automatic QPSA coverage starts on the latest of:

  1. The first day of the plan year in which you attain age 35, or
  2. The date on which you first become a participant, or
  3. The date on which you are first married.

Your election period ends at the earlier of:

  1. Your death, or
  2. Your annuity starting date.

However, if you separate from service of the plan sponsor prior to attaining age 35, the election period begins on your separation from service.

Note: If you are under age 35, you also may elect (with appropriate written spousal consent) to decline automatic QPSA coverage. This election expires at the beginning of the plan year in which you attain age 35, unless you then renew the election and the spousal consent. If you are under age 35 and you want to make this election, you must:

  1. Notify the plan representative,
  2. Secure written spousal consent, and
  3. During the plan year in which you attain age 34, if you wish to renew your election so that it extends beyond the first day of the plan year in which you attain age 35 you will need to complete this form again.

Financial Effect of a Married Participant’s Election to Waive QPSA Coverage

If you are married and do not waive the QPSA, the plan will pay your surviving spouse the QPSA. The QPSA will not pay any further benefits after your spouse dies.

If you are married and waive the QPSA (with spousal consent), your entire vested account balance will be paid to your designated primary beneficiary (or beneficiaries). If any amount remains in the plan when your primary beneficiary (or beneficiaries) die, it will be paid under the terms of the plan. You may designate different beneficiaries to receive their respective portions of your vested account balance under the plan.