Request to Discontinue MEC Health Insurance Plan

Elections for group health insurance are irrevocable for the plan year under Section 125 plans. However, the Internal Revenue Service (IRS) provides specific instances when an employee can make midyear election. Employees must have one of the following "Qualifying Events" to cancel insurance outside of the open enrollment period.
Please place a checkmark next to the reason for cancellation. Check all that apply. *
Note that in order to cancel insurance outside of the open enrollment period, employees must qualify for one of the events above.
Cancellation Signature *
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