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Submit completed cancellation form. Coverage ends on the last day of the month in which the request is received by MCHCP.

Subscribers may cancel medical coverage at any time during the year unless premiums are collected pre-tax through the employer's cafeteria plan. In this situation, subscribers may only cancel coverage if allowed by the cafeteria plan.

Subscribers may only cancel dental or vision coverage during the year if one of the following occurs:

  • Termination of employment or COBRA coverage
  • Retirement
  • Leaveof absence
  • Enrollment in new coverage through other employment
  • When the member enrolls in Medicaid

Subscribers may also cancel medical, dental or vision coverage during Open Enrollment.

Active subscribers who cancel coverage cannot re-enroll until Open Enrollment or a qualifying life event.

Retiree subscribers who cancel coverage cannot re-enroll at a later date.


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