Cancel Requests

Outside of annual enrollment transfer period, an you cannot terminate your health, dental or vision coverage on a voluntary basis unless you experience a special qualifying event, family status change, or other qualifying event as approved by Benefits Administration. There is one exception to this rule. If you are enrolled in the prepaid dental option you can also request to terminate coverage if there is no participating general dentist within a 40-mile radius of your home.


You must notify your Agency Benefits Coordinator of any event that causes you or your dependents to become ineligible for coverage. You must repay any claims paid in error. A refund for any premium overpayments are limited to three months from the date notice is received.



  • You or your dependent must have become newly eligible for other group plan coverage within the past 60 days (the purchase of a private insurance policy is not a valid reason to terminate coverage).
  • You have lost eligibility for the state group insurance plan (e.g., changing from full-time to part-time). When canceled for loss of eligibility, coverage ends the last day of the month eligibility is lost.
  • You must fill out and submit an insurance cancel request application found on the Insurance and Benefits website under Forms: (Note: The insurance cancel request application must be completed in its entirety, to include the employee’s name, and employee Id# and Agency Benefits Coordinator signature).
  • The proper supporting documents must be submitted with the insurance cancel request application. The required documentation can be found on the insurance cancel request application at the above website.


Approved reasons to cancel coverage are:


Optional Accidental Death Insurance

The Optional Accidental Death insurance can be terminated at any time, without a qualifying reason. The coverage will be terminated at the end of the month in which the termination is requested by completion of the Optional Accidental Death Enrollment Application. Even though the form is called an enrollment application, this form is also used to make changes to Optional Accidental Death insurance, including termination of coverage. Contact your Agency Benefits Coordinator to submit an Enrollment Change form.


Coverage Reinstatement Following Voluntary Cancellation

In the event that a policyholder has voluntarily canceled medical insurance coverage for themselves and/or their eligible dependents and wants the coverage reinstated, the policyholder may do so by meeting all of the following conditions:

  • Premiums were paid current on the coverage termination date;
  • The policyholder and/or their dependents continue to meet the eligibility requirements of the plan;
  • The policyholder submits a written request for reinstatement within one full calendar month of the coverage termination date.
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