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Terminating Employee Coverage

Terminating Employment

  1. Plan Administrator completes Notice of Change Form
  2. Email this form to or fax to 1-877-494-0109.
  3. Retain the original for your files. We recommend that you keep the application for a period of one year following the termination date
  4. Ensure the Plan Member's pay-direct drug/id card is terminated as of effective date.