Qualifying Events Forms
|Adobe Acrobat Reader is required to view forms. Download it FREE by clicking icon.
- 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:
- Why coverage was lost or acquired
- What coverage was lost or acquired
- Who is/was covered listing each dependent individually by name
- Effective date coverage was lost or acquired