Change Forms
Change Forms can help you make updates to your group benefit plan. You can use it to modify a group member’s name or marital status, add or remove dependents covered by the plan, update beneficiaries, decline health and/or dental benefits, or even opt out of all benefits under a voluntary plan.
If you have any questions related to your specific situation, please reach out to your Plan Administrator.
-
Change of Beneficiary The file was published on 5/2024
To change a beneficiary on a group insurance plan.
-
Group Alternate Coverage The file was published on 8/2021
Use this form to refuse health and/or dental benefits, and to refuse all benefits under a voluntary plan. Must be completed in conjunction with the Notice of Change form to ensure full details of dependents are provided.
-
Group Life Insurance Conversion Application The file was published on 11/2024
For eligible members converting their lost Group life insurance to an individual policy.
-
Notice of Change The file was published on 5/2024
To change a group member's name or marital status, add or remove dependents covered under the plan, refuse health and/or dental benefits, and to refuse all benefits under a voluntary plan.