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Remove Dependents

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Removing dependents will terminate their coverage. Some removals may qualify for COBRA continuation coverage. Please ensure you have the required documentation for the removal reason.
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Current Dependents
Select dependents to remove from your coverage
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Select
Dependent Name
SSN
Current Coverage
Enrolled Since
Monthly Cost

Sarah Johnson

Spouse β€’ Age 40

***-**-1234

π“π“ˆ–Medical
π“π“ˆ–Dental
π“π“ˆ–Vision
π“π“ˆ–Life

1/1/2020

$450.00

Michael Johnson

Child β€’ Age 15

***-**-5678

π“π“ˆ–Medical
π“π“ˆ–Dental
π“π“ˆ–Vision

1/1/2020

$175.00

Emily Johnson

Child β€’ Age 13

***-**-9012

π“π“ˆ–Medical
π“π“ˆ–Dental

1/1/2020

$150.00

David Johnson

Child β€’ Age 9

***-**-3456

π“π“ˆ–Medical

6/1/2021

$125.00

Margaret Johnson

Domestic Partner β€’ Age 37

***-**-7890

π“π“ˆ–Medical
π“π“ˆ–Dental
π“π“ˆ–Vision

3/15/2022

$400.00

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Important Information:

  • Dependents aged 26+ will automatically lose coverage at the end of the month they turn 26

  • COBRA continuation may be available for qualifying events (additional cost applies)

  • Changes are typically effective the first of the following month

  • You cannot re-add dependents until the next open enrollment or qualifying event

Remove Dependents | ThothOS