Employee Termination Request

Please complete the form below to terminate an employee from coverage. Attach any supporting documents.  

Be sure to offer COBRA/State Continuation coverage if applicable. You can find information and forms on TrustMineral.com; contact us if you don't have your login information. You can also refer to your state's website.

Our service team will be in touch. 

Thank you,
Elite Benefits Service Team
708-535-3006

We will not share your information with any third-party. Privacy Policy.

Employee Termination Request Form


(To select multiple, hold Ctrl or Command)


Be sure to offer COBRA/State Continuation coverage if applicable. You can find information and forms on TrustMineral.com or your states website.


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