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This form is used by Minnesota state employees who are retiring and wish to continue their health, dental, and life insurance coverage. It collects necessary retiree information and details about
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How to fill out request for continuation of
How to fill out REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT
01
Obtain the REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT form from the appropriate agency or website.
02
Fill in your personal information, including your name, contact details, and retirement date.
03
Indicate the type of coverage you are requesting to continue.
04
Provide any required identification numbers or employee ID.
05
Review the instructions on the form to ensure all necessary information is included.
06
Sign and date the form to certify the information is accurate.
07
Submit the completed form to the designated office in accordance with agency instructions.
Who needs REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT?
01
Employees nearing retirement who want to maintain their health benefits.
02
Individuals who have retired from their job but wish to continue their coverage under certain plans.
03
Those eligible under special retirement circumstances that allow them to request continued coverage.
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What is REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT?
REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT is a formal application that allows eligible individuals to maintain their health insurance coverage after retirement under special conditions.
Who is required to file REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT?
Individuals who are retiring and wish to continue their health insurance coverage beyond their retirement date are required to file REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT.
How to fill out REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT?
To fill out the REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT, individuals need to provide personal information, details about their current health plan, and any relevant retirement information as specified in the form guidelines.
What is the purpose of REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT?
The purpose of REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT is to ensure that retired employees can retain their health benefits, allowing for continuous healthcare coverage during retirement.
What information must be reported on REQUEST FOR CONTINUATION OF COVERAGE-SPECIAL RETIREMENT?
The information that must be reported includes the retiree's name, contact information, details of the current health insurance plan, employment history, and any dependents that will be included in the coverage.
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