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Voluntary Termination of Medical/Pharmacy Coverage Instructions Use this form to terminate your medical/pharmacy coverage or terminate dependent medical/pharmacy coverage. Please print legibly keeping
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How to Fill Out Form Instructions - OPERS:

01
Start by carefully reading the form instructions provided by OPERS.
02
Make sure you have all the necessary information and documents required to complete the form. This may include personal identification, social security number, and any relevant financial or employment details.
03
Begin filling out the form by following the specified format and guidelines. Pay attention to any specific instructions regarding handwriting, signatures, and dates.
04
Provide accurate and detailed information on the form. Double-check your entries to avoid any mistakes or errors.
05
If you come across any sections or questions that you are unsure about, refer back to the form instructions or contact OPERS for clarification.
06
Once you have completed the form, review it one final time to ensure all the required fields are filled in correctly and legibly.
07
Sign and date the form as instructed. If there are multiple signatories, make sure each person signs their designated areas.
08
If necessary, make a copy of the completed form for your records before submitting it to OPERS.
09
Finally, follow any additional steps or procedures outlined in the form instructions, such as mailing the form to a specific address or submitting it electronically.
10
Anyone who is an OPERS member or beneficiary and needs to request benefits, update their information, or initiate any other relevant actions may require form instructions - OPERS. These instructions serve as a guide to ensure that individuals provide all the necessary details accurately and meet OPERS' requirements.
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