Episcopal Diocese of Washington
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Health Insurance Information
for Employees Leaving a Position of Employment

How do I cancel my insurance coverage?

The Insurance administrator must receive written notification of cancellation from the congregation employing you (Rector/Vicar or Vestry).

Acrobat Diocese of Washington Request for Cancellation of Insurance [pdf] > See note below

For billing purposes, the diocesan Insurance Administrator must have notification of insurance termination within 30 days of the end of employment so that the Insurance Administrator can send you information about your eligibility for COBRA and/or HIPPO coverage.

How can I continue in the health insurance plan after I leave?

Once the Insurance Administrator receives written notification of cancellation they will send a letter to you offering continuation of coverage.

Who can I contact with further questions?

Contact the diocesan Insurance Administrator.

>> If you do not open this document in your browser, but save it and open it in Acrobat Reader or the full version of Adobe Acrobat, you can type your information directly into the form.
PLEASE NOTE:
If you are using Acrobat Reader, the data you enter will not be saved when you save the file, so you will not be able to e-mail the file to the administrator. Instead, after typing, print out the form and mail or fax it to the administrator. If you are using the full version of Acrobat, the data should save when you save the file, so you can e-mail the form to the administrator. If you have any technical questions, email the webmaster.

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