Update Your Information
- Coverage Request for Incapacitated Dependent
Use this form if you are requesting to continue coverage for a dependent age 26 who is eligible as a mentally or physically incapacitated dependent.
- Prior Health Coverage Information
If you had coverage under a previous plan, perhaps from a previous employer, use this form to receive credit against the waiting period for pre-existing conditions.
Please print out the appropriate forms above and give the completed forms to your Health Benefits Representative/benefits office for processing.