Get Request For Continuation Of Coverage Upon Retirement Form

This guide provides step-by-step instructions for filling out the Request For Continuation Of Coverage Upon Retirement Form online. Completing this form accurately is crucial for maintaining your insurance coverage after retirement.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the Request For Continuation Of Coverage Upon Retirement Form and open it in your editor.
2. In Section 1 – General Information, provide your name, employee ID, address, and other personal details. If applicable, include your spouse’s information. If you do not have a spouse, make sure to select 'No' for spouse coverage.
3. For Section 2 – Continuation of Health Insurance Coverage, indicate whether you or your spouse is eligible for Medicare and whether you currently have Medicare. Specify your current health insurance plan and elect whether you wish to continue coverage for yourself and/or your spouse, remembering that if your spouse does not continue coverage, they cannot enroll in the future.
4. In Section 3 – Continuation of Dental Insurance Coverage, indicate your current dental plan. Decide whether to continue dental coverage for yourself and/or your spouse, and ensure to check ‘Yes’ for your own coverage even if you plan to include others.
5. Proceed to Section 4 – Continuation of Group Life Insurance Coverage, where you will select whether you wish to continue your life insurance policy and complete details regarding optional life insurance for yourself and your spouse.
6. In Section 5 – Continuation of Medical Dental Expense Account (MDEA), state whether you wish to continue your participation in this account on a post-tax basis, keeping in mind that this account is separate from other savings plans.
7. Finally, sign and date the bottom of the form, providing a home phone number. Submit the completed form to your HR representative for their signature, and ensure it is forwarded to the appropriate entities to meet processing timelines.
8. After completing all sections, you may save changes, download, print, or share the finalized form as needed.

Take action now and fill out your Request For Continuation Of Coverage Upon Retirement Form online to ensure your coverage continues seamlessly.