Submit Your Renewal
If this form is returned to Group Health Cooperative of South Central Wisconsin (GHC-SCW) by November 15, 2023, your December invoice will reflect the new 2024 premium.
If received between November 15, 2023, and December 15, 2023, your January invoice will be adjusted to reflect the new premium.
This form must be returned to GHC-SCW before December 15, 2023, for January 1, 2024, effective date for new coverage.
If we do not receive this form back by this date, your individual health insurance plan will renew on the plan closest to your current plan.
**Your application will not be complete until you press the "SUBMIT" button below.**
Thank you!