You may suspend your UC-sponsored retiree medical and/or dental coverage if you are covered by a non-UC group or individual medical and/or dental plan and you meet the provisions below. If you suspend UC medical or dental coverage, you may reenroll during any future Open Enrollment or within 31-days of an involuntary loss of coverage (Proof of continuous coverage and involuntary loss will be required for re-enrollment).

In order to suspend, you must meet all of the following criteria to maintain continuous plan coverage:

• Be eligible for a UC medical and/or dental plan, and
• Be eligible for and enrolled in a non-UC group or individual medical and/or dental plan (e.g., the Tricare for Life medical plan), and
• Submit the UBEN 100 form to suspend UC-sponsored medical and/or dental coverage.

If you  meet these requirements, you can suspend your UC-sponsored coverage.
When your UC-sponsored medical coverage is suspended, the UC employer medical plan contribution and the Medicare Part B reimbursement, if any, will stop.

If you permanently cancel your UC-sponsored retiree medical and/or dental coverage, you may re-enroll only with proof of other continuous coverage under the Involuntary Loss of Coverage provision, not through Open Enrollment.

For more information, contact the UC Customer Service Center at 1-800-888-8267.

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