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Notice of Conversion Rights Important Notice regarding your coverage: If you are an active employee, terminated employee, retiree or dependent who may be faced with losing all coverage or even a portion
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To fill out wwwopmgovhealthcare-insurancehealthcaretermination conversion and temporary, follow these steps:
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wwwopmgovhealthcare-insurancehealthcaretermination conversion and temporary is needed by individuals who are terminating their healthcare insurance and wish to convert it to a temporary coverage. It is generally required by federal employees or their family members who are no longer eligible for the regular healthcare insurance plan and want to avail temporary coverage during the transition period.
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This form is used to report healthcare termination conversion and temporary coverage.
Employers and insurers are required to file this form.
The form must be filled out with accurate information about the healthcare termination and temporary coverage.
The purpose is to report changes in healthcare coverage.
Information about healthcare termination and temporary coverage must be reported.
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