Identity Theft Protection: LifeLock Premium Information

  • Every 2 seconds someone is a victim of identity theft.
  • LifeLock offers 3 layers of identity theft protection:
    1. Detect
    2. Alert
    3. Restore

Plan Coverage



Enrollment Type



LifeLock Dependents

Critical Illness: Allstate Premium Information

  • Guaranteed Issue coverage, meaning no medical questions to answer at initial enrollment for retiree, spouse and child(ren)
  • Benefits are paid direct to you
  • Covers heart attack, cancer, stroke and more

Plan Coverage



Enrollment Type



Tobacco User?


Relationship to Insured

Critical Illness Dependents

Accident: Allstate Premium Information

  • $50 or $75 physician visit twice per year for any reason including sickness
  • Cash benefits are paid directly to you, unless assigned

Plan Coverage




Enrollment Type



Plan Type

Relationship to Insured

Accident Dependents

Life: Fidelity / Combined Premium Information

  • Guaranteed premiums
  • Life Insurance with money for long-term care
  • Family coverage available: spouse, children and grandchildren

For a custom quote call 855-627-3847 or a Benefit Counselor will contact you.

Dental: UnitedHealthcare Premium Information

  • Visit any dentist or dental specialist of your choice
  • No waiting period

Plan Coverage



Enrollment Type



Dental Dependents

Vision: UnitedHealthcare Premium Information

  • Visit Any in-network provider of your choice
  • You may have your eye exam at one location and take your prescription to an in-network retailer to fill
  • No waiting period

Plan Coverage



Enrollment Type



Vision Plan

Vision Dependents

Pension Deduction Authorization I hereby authorize the North Carolina Retirement Systems to deduct my identify theft, critical illness, accident, dental and/or vision premiums from my retirement benefit. To the best of my knowledge, I confirm that the information I have provided on this form is complete and accurate. Firefighters and Rescue Squad Workers, National Guard or Register of Deeds Pension Funds' benefit recipient do not qualify for pension deduction.

Direct Bill Option Please place the benefits that I have applied for on direct bill. Firefighters and Rescue Squad Workers, National Guard or Register of Deeds Pension Funds' recipient do not qualify for a pension deduction Please select the Direct Bill option.

If you would like to review what you are submitting, cycle through the different tabs above to check your work. When you are ready, click the Submit button below

Terms and Conditions I confirm that the information I have provided on this form is complete and accurate. Any person who knowingly and with intent to injure, defraud or deceive any insurer, files a statement of claim or an application containing false, incomplete or misleading information may be prosecuted as allowed by appropriate state law. I hereby authorize the North Carolina Retirement System to deduct my dental, vision and/or accident plan premiums from my retirement benefit period. By Checking the box below, I authorize Pierce Insurance to use my information as reasonably needed to obtain the elected insurance option. The form and the acceptance of terms and conditions will act as the signed document, however Pierce Insurance may request a written signature later if needed.

Check Here to accept terms and conditions