Election Booklet Enrollment Forms Important: Forms are not fillable. County must receive a copy of:
b)acknowledgement and disclosure statement form
c)beneficiary designation in order to enroll participants in the plan.
Note that forms are included in this Enrollment Form booklet (after cover letter). Enrollment Forms for Mass Mutual can be mailed to:
Contra Costa County
Employee Benefits Service Unit
651 Pine Street, 5th Floor
Martinez, CA 94553
or fax to (925) 335-1798
New Enrollment forms must be received by the 25th of the month to be processed for the next 10th of the month pay.
Hardship Withdrawal: Submit forms directly to Mass Mutual. Do not send to Employee Benefits Service Unit
Loan Application: Application must be submitted in person to the Employee Benefits Service Unit for authorization
Notification of Change Form: Use this form to increase or decrease your current contribution amount. Notification of Change forms must be received by the 25th of the month to be processed for the next 10th of the month pay.
Participant Change Form: Use this form for name changes, correction to Social Security Number, Marital Status Change
Rollover forms should be sent directly to Mass Mutual. FAX to (816) 701-8005 or e-mail to firstname.lastname@example.org