How to Waive ICHRA coverage mid-year

If you’ve decided not to participate in an ICHRA, it’s important to officially waive coverage so your choice is properly documented. Follow the steps below to complete the process quickly and accurately.

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Step 1: Complete the ICHRA Enrollment Form

Click the button below to access the ICHRA Enrollment Form.

If you have any questions or need help completing the form, please call our Customer Service team.

ICHRA Waiver Form
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Step 2: Select “Waive”

On the form, choose the “Waive” option to indicate that you are declining coverage for the upcoming plan year.

Step 3: Submit the Form

Submit the completed form to confirm your decision.

This step is required to stay compliant with plan rules—even if you are opting out of coverage.

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CONTACT CUSTOMER SERVICE

Get In Touch

If you have questions about your employer’s ICHRA, our customer service team is here to help. We look forward to supporting you as your ICHRA provider!

Email Us

customerservice@medsurety.com

Call Us​

952-303-5700
1-888-816-4234

Address​

4350 Baker Rd Suite 350
Minnetonka, MN 55343

Working Hours​

Monday – Friday,
8:00 am – 5:00 pm