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Please be informed that in accordance with Maxicare's policy, the only valid reasons for cancellation of

dependent's enrollment within the fiscal year are the following (For each reason, there is a
corresponding proof required for processing.

-Deceased dependent
• Required Document: Photocopy of Death Certificate
-Dependent working/living abroad
• Required Documents: Photocopy of Visa AND Photocopy of Passport/Residence Card/Work Permit
-Covered by another HMO provider
• Required Document: Photocopy of HMO card indicating the validity date. If validity date is not present
on the card, submit a Certificate of Coverage from the HMO Provider
-Dependent gains employment in Accenture
• Required Document: Photocopy of Accenture ID of dependent OR Photocopy of health card
-Single Parenthood
• Required Document: Copy of Legal Separation OR Affidavit of Single parenthood OR Letter addressed
to Maxicare stating single parent status
-Transfer of Dependents (for resigning employees & change of civil status only)
• Required Document: Letter addressed to Maxicare signed by the transferring and accepting employee.
This should be received 30 days prior to resignation or change of status.

Below are the steps in cancelling dependent.

2.) Click enrollment HMO Processing
3.) Click enrollment & cancellation
4.) Click cancel dependent
5.) Choose Reason for cancellation
6.) Submit Changes

Make sure that all requests for cancellation is logged via PDC Benefits Portal - Otherwise, request will be forfeited.

Please place the requirements in a routing envelope and submit via the BENEFITS DROP BOX at the
Reception area. You also need to log the forms that you have submitted in the log sheet that will be
provided. You will be informed within 3-4 working days if there are discrepancies in the forms submitted
and/or the forms indicated in the log sheet.

*Cancellation done and approved on or before the 23rd of the month, the effectivity date is on the first
(1st) day of the following month, deduction will cease on the 15th of the same month (effectivity).

*Cancellation done and approved after the 23rd of the month, effectivity date is on the first (1st day) of
the second succeeding month,deduction will cease on the 15th of the same month (effectivity).

For further information regarding HMO enrollment and Cancellation, you may access this link
and click on HMO Dependents: