OmniForm Form

SEBAC 2011 Option to Retain Grandfathered Normal Retirement Date for
the State Employees Retirement System
STATE OF CONNECTICUT
OFFICE OF THE STATE COMPTROLLER
RETIREMENT SERVICES DIVISION
CO-997 New 1/2013
Page 1 of 3
The 2011 SEBAC Agreement (Agreement) provided current Tier II or Tier IIA non-hazardous duty State Employees Retirement
System (SERS) members who will be employed on or after 7/1/2022 the opportunity for a one-time irrevocable election to retain
that normal retirement age for the full actuarially valued cost. This election has no bearing on early retirement provisions.
Prior to the Agreement, normal retirement eligibility was age 60 and 25 years of Vesting Service or age 62 and 10 years of
Vesting Service. The Agreement changed normal retirement eligibility for Tier II and Tier IIA members who have not yet attained
their normal retirement eligibility and retire on or after 7/1/2022 to age 63 and 25 years of Vesting Service or age 65 and 10 years
of Vesting Service.
Who is Eligible for this Election:
All current, active Tier II and Tier IIA members who were employed prior to July 1, 2011.
Time Period for Election:
Eligible employees must make their irrevocable election by July 1, 2013.
Employee Instructions:
Employees must calculate their additional contribution via the table on this form. This figure must be validated by an authorized
agency employee.
Note: This election is irrevocable. This means that, once this form is received by the Retirement Services Division, this
election cannot be revoked for any reason. The additional contributions will be deducted from your paycheck beginning with the
first full pay period following 7/1/2013 and will not stop until you separate from state service or attain your grandfathered
retirement age, whichever is sooner.
If you terminate with vested benefits prior to your grandfathered retirement age before 7/1/2022, you will FORFEIT these
additional contributions. This means that your additional contributions will NOT be returned to you. If you terminate with vested
benefits prior to your grandfathered retirement age after 7/1/2022, you will receive your excess contributions WITHOUT
INTEREST and be subject to the new retirement age.
If you maintain employment to the new retirement age, your excess contributions WITHOUT INTEREST will be returned to you
upon reaching that age.
Please calculate your additional contribution according to the table below and enter the percentage in Section III of this form.
Should you need assistance, please contact your Human Resources department.
Choose which question pertains to you and then find the appropriate date in the chart.
If you will have 25 years of service prior to turning age 62
What is the first of the month following attainment of age 60 and 25 years of service?
OR
If you will not have 25 years of service prior to turning age 62
What is the first of the month following your 62nd birthday?
Eligibility
Date
Jul-2022
Aug-2022
Sep-2022
Oct-2022
Nov-2022
Dec-2022
Jan-2023
Feb-2023
Mar-2023
Additional
Contribution
0.02%
0.04%
0.06%
0.08%
0.10%
0.12%
0.14%
0.16%
0.18%
Eligibility
Date
Apr-2023
May-2023
Jun-2023
Jul-2023
Aug-2023
Sep-2023
Oct-2023
Nov-2023
Dec-2023
Additional
Contribution
0.20%
0.22%
0.24%
0.26%
0.28%
0.30%
0.32%
0.34%
0.36%
Eligibility
Date
Jan-2024
Feb-2024
Mar-2024
Apr-2024
May-2024
Jun-2024
Jul-2024
Aug-2024
Sep-2024
Additional
Contribution
0.38%
0.40%
0.42%
0.44%
0.46%
0.48%
0.50%
0.52%
0.54%
Eligibility
Date
Oct-2024
Nov-2024
Dec-2024
Jan-2025
Feb-2025
Mar-2025
Apr-2025
May-2025
June 2025+
Additional
Contribution
0.56%
0.58%
0.60%
0.62%
0.64%
0.66%
0.68%
0.70%
0.72%
SEBAC 2011 Option to Retain Grandfathered Normal Retirement Date for
the State Employees Retirement System
STATE OF CONNECTICUT
OFFICE OF THE STATE COMPTROLLER
RETIREMENT SERVICES DIVISION
CO-997 New 1/2013
Page 2 of 3
If you wish to waive your right to make this irrevocable election to retain the grandfathered Normal Retirement Date,
complete Sections I, II, and IV of this form.
Section V must be completed by a notary public for either election.
Employing Agency Instructions:
An authorized agency staff member must sign in either Section III or Section IV. If the employee is opting to grandfather their
Normal Retirement Date, the authorizing agency staff member must validate the percentage entered to be deducted in Section III.
The completed form and all required documentation should be forwarded to the Retirement Services Division, Database Unit, 55
Elm Street, Hartford, CT 06106. The Agency should retain one copy and provide one copy to employee.
I. EMPLOYEE PERSONAL INFORMATION
EMPLOYEE NAME (Last, First, M.I.)
EMPLOYEE NO.
LAST 4 DIGITS OF SOCIAL SECURITY NUMBER DATE OF BIRTH
EMPLOYEE'S HOME ADDRESS (Street No., Name) (City, State, Zip Code)
MARITAL STATUS
MARRIED
DATE OF MARRIAGE
SEX MALE FEMALE
NAME OF SPOUSE
SINGLE
II. EMPLOYMENT INFORMATION
EMPLOYING AGENCY
AGENCY ADDRESS
EMPLOYMENT DATE
EMPLOYMENT STATUS
Full-time
Part-time
III. MEMBER'S REQUEST TO OPT FOR GRANDFATHERED NORMAL RETIREMENT DATE
By completing and signing this form, I hereby certify that this is a one-time election and that my choice to retain my grandfathered
normal retirement age for the full actuarially valued cost is irrevocable, that is, I must continue to pay the additional contribution
until I separate from service or attain my grandfathered retirement age, whichever is sooner. By completing and signing this
form, I further acknowledge that should I leave after I become vested but prior to 2022, I will forfeit my additional contributions.
I also understand that should I work until my new retirement age, I will be refunded my additional contributions without interest.
PERCENT TO BE DEDUCTED FROM WAGES:
(calculated from chart)
%
EMPLOYEE'S SIGNATURE
AUTHORIZED AGENCY SIGNATURE (& TITLE)
DATE
PHONE
DATE
STATE OF CONNECTICUT
OFFICE OF THE STATE COMPTROLLER
RETIREMENT SERVICES DIVISION
SEBAC 2011 Option to Retain Grandfathered Normal Retirement Date for
the State Employees Retirement System
CO-997 New 1/2013
Page 3 of 3
IV. MEMBER'S OPPORTUNITY WAIVER STATEMENT
By completing and signing this form, I hereby certify that I had the opportunity to retain my grandfathered retirement date
pursuant to the SEBAC 2011 Agreement. By completing and signing this form, I further acknowledge that this is a one-time,
irrevocable option and that my choice to waive my right to purchase my grandfathered retirement date is irrevocable; that
is I am subject to the new retirement provisions of the Agreement.
EMPLOYEE'S SIGNATURE
DATE
AUTHORIZED AGENCY SIGNATURE (& TITLE)
PHONE
DATE
V. NOTARY CERTIFICATION
I hereby certify and affirm this form was signed by the person whose signature appears in either Section III or Section IV of this
form.
Signed and sworn before me this _________ day of ____________________ , ___________
Signature of Notary Public: ____________________________________________________
State:
Town:
SEAL HERE
My commission expires
OSC USE ONLY
REVIEWED BY:
PERCENTAGE:
ENTERED BY:
Option to Retain Grandfathered Normal Retirement Date for the State Employees Retirement
System Q & A's
Question
Answer
What does grandfathered normal
retirement date mean?
This is the normal retirement eligibility date prior to SEBAC 2011. It was
either age 60 and 25 years of service or age 62 with 10 years of service.
What if I leave and defer my
retirement date?
The post 2022 retirement age and service will apply. If you leave prior to
7/1/2022 you will also forfeit your additional contributions.
Does this election have any impact
on my early retirement date?
No, the SEBAC 2011 agreement only allows for the ability to retain your
normal retirement date.
What if I have already reached
normal retirement age by 7/1/2022
but still keep working?
You will retain that normal retirement age and NOT be subject to the post
2022 retirement age.
What happens if I make this election
and want to retire early?
You will lose the grandfathered normal retirement date. Your early
retirement reduction will be based on the post 2022 normal retirement age
and service. If you leave prior to 7/1/2022 you will also forfeit your additional
contributions.
What happens if I make this election
and then stay past my grandfathered
normal retirement date?
If you stay past the grandfathered normal retirement date and stay until your
post 2022 normal retirement date, you will receive all of your additional
contributions back but without interest. If you leave after your
grandfathered normal retirement date but prior to your post 2022 normal
retirement date, you will not receive your contributions back but your benefit
will be calculated under the grandfathered normal retirement date provisions.
For how long will these additional
contributions be deducted out of my
paycheck?
The contributions will continue as long as you are in state service until you
reach your grandfathered normal retirement age. If you continue
employment beyond that date, the contributions will stop.