1. Employee completes the Enrollment/Change Form (Form-1) checking off the deletion box and listing spouse’s/dependent’s name, date of birth, relationship to insured, and Social Security Number and attaching documentation of qualifying status change event.
  2. The employee must indicate the reason for the deletion, the effective date (this date cannot be retroactive).
  3. Photocopy the form and documentation of the qualifying status change event and file in the employee’s personnel file.
  4. Send the original form and documentation of qualifying status change event within 60 days of the qualifying status change event.  Forms received after 60 days are returned and the employee may re-apply during Annual Enrollment.

This information provided by the Group Insurance Commission .