Benefit Service Center

Benefit Service Center

My Benefit Service Center

Please note our new mailing address: PO Box 350 Conshohocken, PA 19428

My Benefit Service Center Navigation

The My Benefit Service Center website aims to streamline the administrative tasks associated with managing your account. It simplifies the process by providing participants with a centralized location to access the re- quired forms, offering a convenient and efficient way to access and complete forms for making changes to your account.

My Benefit Service Center generic form quick access.

Cancellation Form:

This cancellation form allows participants to formally request the cancellation of their coverage through My Benefit Service Center.

COBRA Appeal Form:

This form allows participants to request a review or reconsideration of a decision made regarding their COBRA benefits. Once the COBRA Appeal Form is submitted, it will be reviewed and when a decision has been reached as a result of the appeal will be communicated to the participant.

COBRA Qualified Life Event:

The submission of the Qualified Life Events Form serves as a notification to the Benefit Service Center regarding a qualifying life event. By completing this form, the participant expresses their intention to make changes to their benefits as a result of a status change.

Death Certification Form:

The purpose of the Death Certification Form is to create an official document that records the participant’s death. This document is essential for both legal and administrative purposes.

Refund/Transfer Request Form:

The Refund Transfer Request form is used by participants to request the transfer of funds or a refund of unallocated funds from their account with My Benefit Service Center. By completing this form, participants are expressing their intention to have funds transferred or refunded to them based on their specific circumstances and account balance.