Get the free Benefit Change or Cancellation Form - brandeis

This form is used by employees of Brandeis University to request changes or cancellations of their health and dental benefits, including specifying qualifying events and submitting necessary documentation.

How to fill out benefit change or cancellation

How to fill out Benefit Change or Cancellation Form

1. Begin by downloading the Benefit Change or Cancellation Form from the official website or obtaining a hard copy from your HR department.
2. Fill in your personal details at the top of the form, including your name, employee ID, and contact information.
3. Specify the type of benefit change or cancellation by clearly indicating it in the designated section of the form.
4. Provide detailed explanations for the requested change or cancellation in the appropriate section.
5. Attach any supporting documents that may be required to process your request, such as evidence of a qualifying life event.
6. Review all entered information for accuracy and completeness to avoid delays.
7. Sign and date the form at the bottom to confirm that the information provided is correct.
8. Submit the completed form to your HR department via email or in-person, following any specific submission guidelines they provide.

Who needs Benefit Change or Cancellation Form?

1. Employees experiencing a change in personal circumstances that affect their benefits, such as marriage, divorce, birth of a child, or changes in employment status.
2. Individuals who want to cancel or modify their existing benefits due to personal reasons or changes in eligibility.

People Also Ask about

How do I cancel disability benefits?

Form SSA-521 is for individuals who want to withdraw their application for Social Security benefits. It is also completed by representatives acting on behalf of these individuals. After completion, the form is used by the Social Security Administration to process the withdrawal request.

Can you cancel your disability benefits?

If you are eligible, you may receive Disability Insurance (DI) benefits until your expected recovery date provided by your physician/practitioner. There are times, however, when you must notify us to continue or stop your DI benefits.

Can you remove disability?

You can only opt out of Disability Insurance (SDI) if you have an EDD approved: Voluntary Plan: Your employer or most employees at your company can apply for a Voluntary Plan to replace SDI. For more information visit: Voluntary Plan Information.

Can you stop receiving disability?

The termination of benefits in the Social Security disability program is based predominantly on four factors: conversion to the retirement program (that is, attainment of full retirement age), death, medical recovery, and work recovery.

Can I cancel disability insurance anytime?

When can you cancel disability insurance? You can generally cancel your policy at any time, but you may want to keep your coverage unless you're certain you can pay for all your expenses should a serious illness or injury leave you without an income.

For pdfFiller’s FAQs

What is Benefit Change or Cancellation Form?

The Benefit Change or Cancellation Form is a document used to notify an employer or benefits provider about changes in an employee's benefits status or to cancel benefits.

Who is required to file Benefit Change or Cancellation Form?

Employees who experience changes in their eligibility or wish to cancel their benefits are required to file the Benefit Change or Cancellation Form.

How to fill out Benefit Change or Cancellation Form?

To fill out the form, provide personal information such as your name, employee ID, and the specific benefit changes or cancellations you are requesting, along with the effective date.

What is the purpose of Benefit Change or Cancellation Form?

The purpose of the form is to officially communicate any changes or cancellations in benefits to the employer or benefits provider, ensuring accurate record-keeping and benefit management.

What information must be reported on Benefit Change or Cancellation Form?

The form must include the employee's name, contact information, type of benefits being changed or canceled, reason for the change or cancellation, and the effective date of the changes.