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Kern County Retiree Health Plans 2018 Open Enrollment Request for DisEnrollment Effective Date: 01/01/2018PLEASE PRINT RETIREE/MEMBER LAST NAMEFIRSTM. I.SOCIAL SECURITY NUMBERADDRESSCITYSTATEZIPTELEPHONEDATE

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How to fill out retiree request for dis-enrollment

01

Step 1: Obtain a retiree request for dis-enrollment form from your benefits office or download it from the official website.

02

Step 2: Fill out the form with accurate and complete information, including your personal details, retiree identification number, and reason for requesting dis-enrollment.

03

Step 3: Attach any supporting documents required by your benefits office, such as proof of other healthcare coverage.

04

Step 4: Review the form and documents to ensure everything is filled out correctly and all necessary attachments are included.

05

Step 5: Sign and date the retiree request for dis-enrollment form.

06

Step 6: Submit the completed form and any accompanying documents to your benefits office either in person, by mail, or through any other designated submission method.

07

Step 7: Keep a copy of the submitted form and documents for your records.

08

Step 8: Follow up with your benefits office to confirm receipt of the retiree request for dis-enrollment and to inquire about the processing timeline.

Who needs retiree request for dis-enrollment?

01

Any retiree who wishes to dis-enroll from a specific healthcare plan or coverage needs to submit a retiree request for dis-enrollment.

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What is retiree request for dis-enrollment?

Retiree request for dis-enrollment is a form that retirees can submit to cancel their enrollment in a certain program or service.

Who is required to file retiree request for dis-enrollment?

Retirees who wish to cancel their enrollment in a certain program or service are required to file retiree request for dis-enrollment.

How to fill out retiree request for dis-enrollment?

Retirees can fill out the retiree request for dis-enrollment form by providing their personal information, the program or service they wish to cancel their enrollment in, and the reason for dis-enrollment.

What is the purpose of retiree request for dis-enrollment?

The purpose of retiree request for dis-enrollment is to allow retirees to cancel their enrollment in a program or service that they no longer wish to participate in.

What information must be reported on retiree request for dis-enrollment?

The retiree request for dis-enrollment form must include the retiree's personal information, the program or service they wish to cancel their enrollment in, and the reason for dis-enrollment.

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