Your coverage will terminate under this Plan on the earliest of any of the following dates:

  • If enrolled in the DMO Plan Option – the last day of the month in which we receive your written request for voluntary termination provided your request is received in the SAMBA office by the 10th of the month (or the 2nd pay period after we receive your request if paying through payroll allotment).
    Note: DMO termination requests received after the 10th day of any month may have a two month delay before coverage actually terminates.
  • If enrolled in the PPO Dental Plan Option – the last day of the month in which we receive your written request for voluntary termination, provided your request is received in the SAMBA office by the 10th of the month (or the 2nd pay period after we receive your request if paying through payroll allotment);
  • The date you cease to make the required premium payments when due;
  • The date you enter active full-time military service for any country (full-time military service does not include service of one month or less). You must notify SAMBA immediately regarding your active military status;
  • The date you are no longer employed by a Federal agency (does not include retirement). You must notify SAMBA immediately upon leaving employment with a Federal agency; or
  • The date the Plan is terminated.

Your dependent’s coverage will terminate under this Plan on the earliest of any of the following dates:

  • The date your coverage terminates;
  • The date your dependent enters active military service for any country (full-time military service does not include service of one month or less); or
  • The date your dependent ceases to be an Eligible Dependent.
    Note: It is your responsibility to notify us when you or one of your dependents loses eligibility. Notification should be received by SAMBA within 30 days of the event (whenever possible). There will be no refund of premium if this requirement is not met.

Termination of coverage for any reason for you or your eligible dependents restricts re-enrollment in the SAMBA Dental and Vision Plan for 24 consecutive months from the date of termination.