Retiree Group Insurance Benefits
To enroll for coverage, complete the form and submit it to the Office of Group Insurance. In order for the coverage to be effective on the first day of the month following the date active employee coverage terminates, your enrollment form must be submitted within sixty (60) days of the date that the active employee policy ends. If your enrollment form is submitted after the sixty (60) day enrollment period, you will be considered a late enrollee and coverage will be effective the first day of the month following the date of application.
If you decide that you want to terminate your enrollment in our group plan, you need to print the Declination of Benefits form, complete the section to decline coverage, and mail it to us.