Alaska DRB gen023: Physician's Certificate for COLA

Alaska PERS and TRS retirees normally lose the Alaska Cost-of-Living Allowance if they leave the state for more than 90 days in a row. This one-page Physician's Certificate is the medical exception: a licensed physician certifies that the retiree must seek temporary medical attention outside Alaska because of an illness, for an absence of up to six months.

Who completes it

The retiree completes the member section with retirement identification number and departure date, and certifies that their domicile remains in Alaska. A licensed physician completes the physician section, stating how many months of continuous absence the illness requires and when it should begin, then signs.

Submitting and payment

How to submit it
The retiree returns the completed certificate to the Alaska Division of Retirement and Benefits by mail or fax.

Good to know

  • The exception rests on AS 39.35.480 (PERS) and AS 14.25.142 (TRS), which otherwise bar a continuous absence from Alaska of more than 90 days for COLA eligibility.
  • The absence covered by this certificate cannot exceed six months from the retiree's date of departure from Alaska.
  • A retiree who builds a recurring pattern of absences over 90 days may be asked for residency information under 2 AAC 35.240.
  • This is not a disability retirement form; the Division describes PERS and TRS disability benefits in separate brochures.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Certificate (Alaska Cost-of-Living Allowance)

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What does the physician certify on Alaska form gen023?

That the physician is licensed to practice and that the patient must seek temporary medical attention outside Alaska as a result of an illness. The physician also states the number of months of continuous absence the illness will require and the date the absence should start, then signs, dates and prints their name.

How long can an Alaska retiree be away under the COLA medical exception?

Up to six months from the date of departure. Without the exception, AS 39.35.480 and AS 14.25.142 stop the Alaska COLA after a continuous absence of more than 90 days. The retiree also certifies that Alaska remains their principal domicile and that they intend to return once the illness is resolved.