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You can add or remove qualified dependents from your Plan any time there is a Qualifying Event (i.e., birth, death, marriage, divorce, gain or loss of other coverage) or during an annual Open Enrollment period (if applicable).

To add a dependent, please complete the Enrollment Form.  You must return all required documents before your dependent(s) can be added.  You should also notify your employer of any changes.  If you have questions about completing the form, you may contact Allegiant Care at 1-800-248-9732.