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Summary

A Medical Insurance Plan (MIP) member may choose to cancel Active Medical Insurance Plan (AMIP), Continuation Medical Insurance Plan (CMIP), or Retiree Medical Insurance Plan (RMIP) because of enrollment into other medical insurance plans or any other reason.

Attention:

RMIP and CMIP cancellation is irrevocable.

AMIP can be reinstated without medical underwriting of the staff member or his/her spouse. It can be reinstated subject to loss of coverage due to:

• Employment status change. This includes termination of employment, change in work shift, change in work site, reduction in hours of employment, or commencement of unpaid leave of absence.
• Death of spouse or registered domestic partner
• Divorce or legal separation
• Loss of entitlement to Medicare or Medicaid

This checklist outlines the steps for cancelling AMIP, RMIP, and CMIP.

to request cancellation.

Send an email to the staff member with a personalized package that includes the appropriate withdrawal form.

Complete and return the withdrawal form to HR Operations.

Send confirmation email to staff after processing the request.

It generally takes five business days from the receipt of the required documents for HR Operations to process the request.

Cancellation is effective from the first of the month following receipt of the request.

Contact PayFlex¡ªretirees may refer to the monthly billing statement.

Attention:

You do not need to notify HR Operations as cancellation of CMIP is done directly through PayFlex.