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.
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Change of Beneficiary 5/2024
To change a beneficiary on a group insurance plan.
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Group Alternate Coverage 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.
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Notice of Change 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.
