Are you already an Individual Plan member and need to make changes???

Why do you need the Change of Status Form?

• You want to add or remove dependents.
• You had a qualifying event change in your family.
  (Marriage, Divorce, Adoption, Birth, Other)
• You want to change your name or the name of one of your dependents.
• You want to change your address.
• You want to change your coverage type.
• You want to make changes to your EFT payment account.

ONLY adding vision coverage to your dental policy, CLICK HERE.

NOTE: Changes due to qualifying events must be submitted within 31 days from when the event occured. Any changes you would like to make to your plan can be submitted through a change of status form on your renewal date.