• Retiree Benefits Continuation Information Form

    Retiree Benefits Continuation Information Form

    This form is for employees interested in continuing eligible health benefits after retirement. Please complete this form before your retirement benefits meeting. The information you provide will help me prepare for our meeting and ensure I have the details needed to discuss your retirement benefit options and answer your questions. Please Note: Eligibility to continue retirement benefits is based on your FRS retirement eligibility, years of MCG service, and age.

  • EMPLOYEE INFORMATION

  • Date of Birth:*
     - -
  • Agency:*
  • Format: (000) 000-0000.
  • Preferred Contact Method:*

  • RETIREMENT INFORMATION

  • Expected Retirement Date*
     - -
  • What best describes your current retirement planning status?*
  • Retirement Plan:*

  • Please contact the FRS Coordinator for your agency.

  • MEDICARE INFORMATION

  • Will you be 65 or older at the time of your retirement?*

  • MEDICARE ENROLLMENT INFORMATION

  • Medicare-Related Retirement Insurance Information


    If you will be age 65 or older at retirement and are interested in the County-sponsored Transamerica Medicare Supplement plan, you are encouraged to schedule a complimentary consultation with Baacke Insurance Agency before scheduling your retirement enrollment appointment with our office.

    Baacke Insurance Agency administers the County's Medicare Supplement plan and can explain your Medicare options, review plan details, and provide premium information.

    PLEASE NOTE: Because our office is not authorized to provide Medicare advice, please contact Baacke Insurance Agency or the Social Security Administration with any questions regarding Medicare eligibility, enrollment, coverage, or effective dates.

    You may begin enrolling in Medicare up to 90 days before you need your coverage to become effective. If you are unsure when your Medicare coverage should begin, please contact Baacke Insurance Agency or the Social Security Administration.

    Medicare Requirements

    • If you do not have Medicare Part A, both Part A and Part B must be effective on the first day of your retiree medical coverage.
    • If you already have Part A, Part B must be effective on the first day of your retiree medical coverage.
    • At your retirement enrollment appointment, you must provide proof of your Medicare Part A and Part B enrollment, including the effective dates. Retiree enrollment cannot be completed until this documentation is received.
    • If you are eligible for the Manatee County Government retiree medical subsidy, you must still schedule an appointment with our office to complete and sign your retiree medical enrollment paperwork.

    To schedule a complimentary consultation with Baacke Insurance Agency regarding the County-sponsored Transamerica Medicare Supplement plan, please call (941) 907-4300.

    Please note:

    • Dental and vision coverage are not affected by Medicare and may be continued separately.
    • You may only continue benefits in which you are actively enrolled at the time of retirement.

  • RETIREMENT BENEFITS SELECTION:

  • Benefits I am interested in continuing in retirement (Please note: You may only continue benefits in which you are actively enrolled at the time of retirement.):*
  • Are you currently covering a spouse or dependents?*

  • Request a Rate Sheet

  • Would you like to receive the 2026 retiree premium rate sheet?*

  • Review/Submit

  • Should be Empty: