Cancellation Form - Voluntary Benefit Coverage 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information, including the Policy Owner’s Name and Mailing Address. Ensure that you check the box if this is a new address.
  3. Provide your contact details, including Home Phone Number and Email. Select your preferred contact number and indicate the best time to reach you.
  4. In Section 1, specify any policy changes you wish to make. Check the appropriate boxes for changes such as coverage type or adding dependents.
  5. For Flexible Premium Payment Changes, indicate whether you want to place the policy in non-billing status or change the premium amount. Specify how often payments will be made.
  6. If applying for a duplicate policy, certify that the original has been lost or destroyed by signing in the designated area.
  7. Complete any additional instructions in Section 4 and ensure all required signatures are provided before submitting your form.

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Also called supplemental benefits, voluntary benefits are used to meet a diverse range of needs. Examples include paying for out-of-pocket medical expenses, household bills and travel expenses, as well as replacing missed wages.
Key takeaways. You can cancel at any time, but re-enrollment is limited to Open Enrollment or qualifying life events. Employer-sponsored coverage is the most restricted. Marketplace and private plans can be cancelled anytime, but you risk going uninsured if you dont qualify for a Special Enrollment Period.
Clearly state the specifics of the cancellation: Indicate if the cancellation is an insured-requested cancellation, carrier-initiated, or due to nonpayment. Provide the precise effective date and time. Include the reason for cancellation explicitly.
You can typically withdraw up to the amount youve paid into your policy. If you want to withdraw the full amount, you will need to surrender your policy, and youll no longer have life insurance coverage.

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