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When your dependents no longer meet eligibility requirements their coverage ends the last day of the month they became ineligible. Spouse - 1 Child - 2 Permanent Legal Guardianship - 3 Collateral Dependent - 4 Add Drop Name First MI Last Male Female Relationship part 4 Subscriber Certification I authorize deductions of the required contributions if applicable. Members may make changes to their plan if they experience a qualifying status change but they may not elect a different plan. If you...

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