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...P o box sacramento ca calpers or fax www gov california public employees retirement system date recipient name address id sample cancellation notice dear participant your dependent s will be deleted from health and dental coverage effective if you do not take action to re verify by due ensure only eligible dependents of state retirees are enrolled in employer sponsored government code section regulations requires the eligibility at least once every three years this letter outlines instructions for each with all requested information must provided order continue receiving avoid being cancelled on st verification is processed after birth month retroactive premiums may owed resulting an accounts receivable have previously required documentation outside effort while working again any listed affidavit comply requirement retain documents account provide issued marriage certificate domestic partnership registration certificates stepchildren partner children remains current who require spouse ...