WAEPA Member Request form to Decrease Coverage

Now you can securely request to decrease your coverage, track your request status, and see your new coverage in your account all within the Member Portal.

Enter your details below and submit a request to decrease your coverage.

"*" indicates required fields

Member Name*

First Last

Your Member ID or Certificate Number

Last four digits of SSN*

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Country

Phone Number*

Are you Decreasing Coverage?

Select a Covered Participant*

Select a Plan*

Select new coverage amount*

What is your reason for decreasing coverage?*

Other Reasons

When would you like for this to go into effect?*

Anniversary date

Next bill date

Select a date

Date*

Comments

*Required fields