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Notifying Us of a Termination

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It is important to notify us right away when coverage is ending for a member of your group. Be sure to notify us when: 
a member of your group divorces (for termination of former spouse)
an employee’s death occurs (even if dependents are electing coverage under COBRA)
an employee or a spouse and/or dependent becomes ineligible for coverage
an employee leaves your group
a dependent child reaches age limit of group or marries
a dependent dies
 
There are two ways to communicate a termination to us: 
Complete a Member Change Form,
or
Fill in the cancellation information on your Group Payment Transmittal (part of your Group Bill).
 
Submitting termination information prior to the effective date reduces the chance of paying claims for services rendered after a member’s termination date. You can inform us any time before or during the month the termination is to be effective, and you may request a specific effective date for the termination. All requests should be received within 60 days of the termination date. 
 
Canceling Coverage of Employees and Family Members
How to cancel coverage:  
To cancel coverage for a member of your group, the Member Information and Termination of Membership sections of the Member Change Form must be completed. As the Group Administrator, either you or the terminating employee may complete this form, but the form must be signed by you.
Terminations may also be written in on Group Payment Transmittals, but you are encouraged to fax in all terminations as soon as they are known.
 
When an employee’s coverage is terminated, the coverage for his or her spouse and
child(ren), if any, also ends. 
All retroactive cancellations must be received within 60 days of the requested effective date. 
 
 
Removing a Family Member from an Employee’s Coverage
The employee should submit a Member Change Form, completing the Member Information section, Change in Type of Membership section (where the employee writes the name of the dependent whose coverage is to be terminated), and Termination of Membership section. The employee needs to sign the form and return it to you for submission to us. 
 
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use