Benefits. Simplified.

Use this form to request cancellation of an employee’s benefits when someone leaves your organization or loses eligibility. We’ll review the details and help ensure the change is processed correctly.

If your group health plan is self-funded, please use our separate cancellation request process so we can coordinate correctly with your plan administrator.

When an employee’s benefits end, they may have the right to continue coverage through COBRA or State Continuation. We’ll provide the necessary resources and guidance on continuation when we cancel an employee from your plan. For more details, visit our COBRA and State Continuation page.