There are many situations that require changes in your enrollment – adding or terminating employees, adding or removing dependents, name or address changes and more.  It’s extremely important to keep records up-to-date. 

When these situations occur, please have the appropriate forms completed and submit the forms to PA Chamber Insurance immediately. The forms are available on the website to download or you may submit enrollment or changes electronically by logging in to the Your Advantage, the secure section of our website specifically for Benefit Administrators.

Please do not wait until the end of the month to forward update forms to PA Chamber Insurance. To ensure the best service, please submit all changes at the time of the event.

 As always, you may mail or fax these forms to us, or submit them through our website.

Fax: 717.720.5598

Mail to:
PA Chamber Insurance
Attn: Operations Center
417 Walnut Street
Harrisburg, PA 17101

Web: Log on to Your Advantage

For your information, enrollment changes may be made retroactive for a maximum of 30 days. Coverage change rules are set forth by the insurance carriers, in accordance with existing laws and internal policies.

Adding New Employees

If you are submitting the enrollment via fax or mail, have the employee complete and sign the appropriate carrier enrollment form. All enrollees must also complete an enrollment form to designate a beneficiary for the Group Term Life benefit. The Benefits Administrator must verify the effective date on the application, the benefits selected and ensure the application is signed.

Note that new coverage is only effective the first of each month.           

Terminating Employees


To terminate coverage, complete the appropriate carrier forms (see Enrollment Forms) and, if appropriate, attach to the Enrollment Summary Form. As mentioned above, include the employee's social security number, name, mark 'T' for Terminated Employee and note the effective date of the termination.
Note that Terminations are effective the last day of the month.

Qualified Status Changes

All elections made during the enrollment period will remain in effect until the next open enrollment period, unless one of the following events occurs:

• Marriage or divorce
• Death of a spouse
• Birth or adoption of a child
• Substantial change of employment status
• Termination or commencement of a spouse's employment

If one of these events occurs, the employee may be eligible to change their coverage election. It is the employee's responsibility to notify the Benefits Administrator of the qualifying event within 31 days of the event. The change will become effective on the first of the month following the date of the qualifying event.

Changing Existing Employee’s Coverage

To change an existing employee's coverage, submit a completed carrier change form (see Enrollment Forms) with an optional Enrollment Summary Form. In most cases, an employee must wait until the next Open Enrollment period to change existing benefits. To determine when a change is permitted outside of Open Enrollment, please refer to Qualified Status Changes above.

Adding/Removing Dependents
To add or remove dependents, complete the appropriate carrier enrollment/change form (see Enrollment Forms). Note the effective date of the change in the appropriate space. Submit this form to PCI Insurance via fax or mail or via the website by logging on to Your Advantage.

Name/Address Changes


For the insurance carriers to administer consistent coverage for your employees, it is important to notify PCI Insurance of any name or address changes within 30 days of the change. To submit a change, complete the appropriate carrier enrollment/change form (see Enrollment Forms) and include it with an optional Enrollment Summary Form. Fax or mail all forms to PA Chamber Insurance or log on to Your Advantage to submit the change electronically.

For additional details regarding your benefit program administration, please visit our Frequently Asked Questions page.

Of course, you can always Contact Us with any questions. Our experienced team is eager to assist you.

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