Municipal Enrollee Enrollment and Change Form (Form 1-MUN) pdf format of    Form1muni.pdf  - This form must be completed for all participating municipal employees terminating municipal service, and for layoffs and retirement.

COBRA Notices, Rates and Application doc format of    cobraappfy15.doc  - for employees to continue health coverage for up to 18 months after coverage as an insured employee ends. For terminations on or after May 1, 2014.

COBRA Notices, Rates and Application doc format of    COBRAappFY14.doc  - for employees to continue health coverage for up to 18 months after coverage as an insured employee ends. For terminations through April 30, 2014. 

HIPAA Notice of Portability Rights pdf format of    hipaanotice.pdf  - this notice describes certain HIPAA protections available to you under federal law when changing your health insurance coverage.

 

Non-Group Conversion - For Non-Group conversion, contact your Plan.


This information provided by the Group Insurance Commission.