How do I remove a family member from my insurance?

Complete a UPAY 850 form, indicating the dependent you wish to remove. Send it to your Benefits Office.

You may remove a dependent from your insurance at any time.

If your dependent has lost eligibility involuntarily (i.e. due to divorce, marriage or change in tax dependency), you must also complete a UBEN 109. The dependent may be eligible to continue coverage under COBRA. The Benefits Office will provide the COBRA packet directly to the dependent.

• See the Group Insurance Eligibility Factsheet for information about dependent eligibility.