Qualifying Events Forms



Qualifying Events Forms

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  • Please contact the Benefits and leave administration department for any questions and forms you need for a Qualifying Event. Department is divided by employee's last name:


Please click here for change form

Required documentation must be submitted with completed form(s). Fax form(s) and required documentation to 678-301-6054.
  • Letter from spouse's current or former employer on company letterhead stating the following four items:
    1. Why coverage was lost or acquired
    2. What coverage was lost or acquired
    3. Who is/was covered listing each dependent individually by name
    4. Effective date coverage was lost or acquired