Note: Do not use these forms for same-carrier plan changes (e.g. Cigna Preferred HMO to Cigna Choice PPO) as Cigna might disenroll the wrong plan! Only use these forms for cross-carrier plan changes.
Disenrollment Forms
Disenrollment Forms
Disenrollment Forms
Disenrollment Forms
Disenrollment Forms
When your client doesn't want it
Members can cancel their enrollment application if the future plan has not yet taken effect by contacting the carrier directly or by filling out the appropriate disenrollment form.
For your convenience, we have listed these forms here. Some carriers offer an online form, while others require a PDF to be signed and submitted.
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