Membership Checkout Membership Level change You have selected the New Retiree membership level. The price for membership is $0.00 Membership expires after 1 Year. Account Information Already have an account? Log in here Username Password Confirm Password First Name Last Name Email Address Confirm Email Address Full Name LEAVE THIS BLANK Retirement Date Retirement Date Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 Earlier About You Enter your basic contact information in the fields below. Preferred Name What do you prefer to be called? (e.g. "Bill" instead of "William") Birth Date JanFebMarAprMayJunJulAugSepOctNovDec Addresses Enter your primary, and (if applicable) secondary addresses in the fields below. Primary Address City State Michigan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Do you have another address at which you can be reached? Yes No Alternate Address City State Michigan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Dates at Primary Address Dates at Alternate Address Phone Numbers Enter your phone number(s) below. Phone (Home) Phone (Cell) Preferred Contact Number Home Cell Retirement Information Please enter details about your retirement from an MEA Family company in the fields below. Are you receiving benefits as a beneficiary of an MEA Famly retiree? Yes No Retiree's Name (if you are a Beneficiary) If you are not a beneficiary, you do not need to fill out this field. When did you/the retiree retire from employment? Enter the date, year, or "Not Sure" From which MEA Family company did you/the retiree retire? MEA MESSA MEA-FS MEDNA From which position did you/the retiree retire? ASO SSA LOS/ALOP PSA MEDA Management 1-8 Management 9+ Which benefits do you receive from the MEA Family company? Pension Additional Pension through Benefit Restoration Plan LMS Health Insurance and Medicare Part D Rx (Over 65) MESSA Choices Health Plan with SaverRx (Under 65) Vision Dental Cash-in-Lieu Medicare Part B Reimbursement for Self Medicare Part B Reimbursement for Spouse Disability (Are you provided a pension and medical insurance because of a disability?) Please select all that apply. To select multiple items, hold down the Control/Command key. Beneficiary Information If you selected a retirement option (at the time of your retirement) that allows a beneficiary to continue to receive your pension and/or health benefits after your death, please enter their information below. Beneficiaries who continue to receive benefits from an MEA Family company after your death are eligible to become RSA members. Do you have a qualified/eligible beneficiary as defined above? Yes No Name of Beneficiary Address City State Michigan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Phone (Home) Phone (Cell) Email Relationship to you? Emergency Contact If you would like to designate an emergency contact, please enter their information below. We will only reach out to your emergency contact if we are unable to reach you directly. Name Address City State Michigan Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming ZIP Phone (Home) Phone (Cell) Email Relationship to you? Processing...
