VBA Deletions and Termination

  • * - Denotes a required field
    Complete the form below to request that an employee be removed from VBA coverage
  • Employees/dependents terminated on the last day of the month-you may terminate employees/dependents up to 60 days prior to today's date
    MM slash DD slash YYYY
  • By typing your name your are certifying that you have authority to administer these benefits, your name will act as an electronic signature
  • A confirmation e-mail will be sent at your attention