Changes In My Family/Dependents

My spouse or dependent is deceased

There’s a new child in my family

My child is now age 26 or is no longer eligible for coverage through Mission

Whatever your life change, you’ll likely need this form to report a change in your benefits status. Once it’s completed, return it with supporting documentation to:

By Email:
Questions? Contact HR Direct Connect by phone at (828) 213-5600

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