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Notifying Us of a Termination

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
To notify us of a termination, please complete a Cancellation Authorization Form.  
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. Additionally, please note that our policy is to only refund current plus 60 days.  
Canceling Coverage of Employees and Family Members
How to cancel coverage:  
To cancel coverage for a member of your group, please complete a Cancellation Authorization Form and fax it to the appropriate number:

Small Group (2-50 employees): (404) 842-8800

Large Group (51+ employees): (404) 842-8580

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 Cancellation Authorization Form, completing all necessary fields including Dependent Name to be cancelled, Cancellation Effective Date, and Coverage Being Cancelled. The employee needs to sign the form and return it to you for submission to us.  
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.