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EMBARK RETIREE SUSPENSION OF COVERAGE FORM Retiree Name: Retiree SSN: Effective Date: (Please print) (This date must be the first day of a month) Forms received prior to the 15th of the month, will
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How to fill out embarq retiree suspension of

How to fill out embarq retiree suspension of:
01
Obtain the necessary form: You can request the embarq retiree suspension of form from your HR department or the company's retirement benefits department. Alternatively, you may be able to find and download the form from the company's intranet or retirement benefits website.
02
Provide personal information: In the form, you will need to fill in your personal information such as your name, employee ID, contact details, and any other required identification information.
03
Specify the suspension period: Indicate the start and end dates of the suspension period you are requesting. This could be a temporary suspension due to specific circumstances or a permanent suspension.
04
State the reason for the suspension: Provide a clear and concise explanation for why you are requesting the suspension. Make sure to include any supporting documents or evidence if required.
05
Signature and submission: Read through the form carefully, ensuring that all the necessary fields are completed accurately. Sign and date the form. Submit the completed form as instructed, either through a designated HR mailbox or by delivering it in person.
Who needs embarq retiree suspension of:
01
Employees planning to take a leave of absence: If you are an embarq retiree and are planning to take a temporary leave of absence, such as for personal reasons, medical leave, or sabbatical, you may need to request a suspension of your retiree benefits during that period.
02
Individuals facing financial hardship: If you are experiencing financial difficulties and cannot afford to pay the required retirement benefit contributions, you may need to apply for a suspension of your retiree benefits until you are able to resume making contributions.
03
Those transitioning back to work: If you have returned to work after retirement and your employer provides medical or other benefits, you may need to suspend your embarq retiree benefits while you are receiving benefits through your employer.
It is important to consult with your HR department or the company's retirement benefits department for specific eligibility criteria and instructions on how to fill out and submit the embarq retiree suspension of form.
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