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This document is used by retirees of Union Pacific to request cancellation or changes to their medical election under the retiree medical program. It includes sections for personal information, coverage
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How to fill out request to cancel or
How to fill out REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION
01
Obtain the REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION form from the designated source.
02
Fill in your personal information at the top of the form, including your name, address, and retirement identification number.
03
Indicate the specific medical election you wish to cancel or change.
04
Provide a clear reason for the cancellation or change, if required.
05
Review all information filled out on the form to ensure accuracy.
06
Sign and date the form at the bottom where indicated.
07
Submit the completed form to the appropriate contact as stated in the instructions, either via mail or electronically.
Who needs REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION?
01
Retirees from Union Pacific who wish to modify their medical election.
02
Individuals who need to cancel their existing medical coverage for any reason.
03
Members who have experienced changes in their healthcare needs and require an adjustment in their enrollment.
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What is REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION?
The REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION is a formal document that allows retirees of Union Pacific to either cancel or modify their choices regarding medical coverage elections.
Who is required to file REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION?
Retirees of Union Pacific who wish to change or cancel their elected medical benefits are required to file this request.
How to fill out REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION?
To fill out the REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION, retirees should complete the form by providing required personal information, selecting the desired changes, and submitting it according to the specified procedures.
What is the purpose of REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION?
The purpose of this request is to allow Union Pacific retirees the flexibility to alter their medical benefit elections as their needs change over time.
What information must be reported on REQUEST TO CANCEL OR CHANGE UNION PACIFIC RETIREE MEDICAL ELECTION?
The information that must be reported includes the retiree's personal identification details, previous election choices, the changes being requested, and any necessary supporting documentation.
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