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Temporary Continuation of Coverage Benefits Enrollment Form

If you were hired on or after October 1, 1987, you may have participated in the District health care program. If applicable, you may complete this form to enroll in the District's Temporary Continuation of Coverage (TCC) within certain periods of a qualifying event or receiving notice of eligibility.  The premiums for this coverage are included in the form. Additional information about TCC qualifying events can be found on pages 8 and 9 of the DPM issuance.